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Barker F, Jha R, Morrish J, Sah A, Choudhary R, Walker RW, Lavender M. Assessing the health impacts of implementing a 'Comprehensive Rural Health Project' health system in a low-income region of rural Nepal. PLOS GLOBAL PUBLIC HEALTH 2025; 5:e0004458. [PMID: 40299891 PMCID: PMC12040125 DOI: 10.1371/journal.pgph.0004458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Accepted: 03/06/2025] [Indexed: 05/01/2025]
Abstract
Establishing and building grassroots, community-based healthcare systems is a key approach to improving healthcare access sustainably in low-income regions of the world. One prominent early example of this was the Comprehensive Rural Health Project (CRHP), inspiring the framework for subsequent large-scale programs globally. However, many community health projects do not provide the same breadth of services as CRHP, which may have impacts on health outcomes. This qualitative study focused on 12 Dalit villages in rural Nepal following an intervention - known as the Village Alive Project (VAP) - to boost healthcare provision through a CRHP-style health system. Villagers' and health workers' impressions of changes in healthcare access were assessed through 42 semi-structured interviews. Thematic analysis was performed using NVIVO by two independent authors; themes were finalized by reaching consensus. Three generated themes were shared by VAP and control villages: 'changes in access to healthcare services'; 'changes in health promotion and disease prevention' and 'inequalities and their effects on health'. A fourth theme, 'views on the expansion of VAP to non-VAP villages', was generated uniquely for the control group. Lack of health education and sanitation facilities, as well as social stigma, were listed as barriers to health prior to VAP's establishment; most participants felt these have been largely addressed since the arrival of VAP. Implementing more comprehensive primary healthcare on top of pre-existing community-based healthcare systems is feasible, with encouraging findings from this low-income region of rural Nepal. Participants felt VAP improved understanding of diseases such as leprosy, which may benefit future vertical interventions. Improvements in various aspects of health and healthcare were reported for most or all study themes across intervention-group villages; improvements were also noted in control villages but with more evidence of ongoing barriers to health. Further studies looking at key quantitative outcomes are required to triangulate findings.
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Affiliation(s)
- Fred Barker
- The Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
- Newcastle University, Newcastle-upon-Tyne, United Kingdom
- Northumbria Healthcare NHS Foundation Trust, Cramlington, United Kingdom
| | | | - Jasmine Morrish
- Newcastle-upon-Tyne NHS Trust, Newcastle-upon-Tyne, United Kingdom
| | | | | | - Richard W. Walker
- Northumbria Healthcare NHS Foundation Trust, Cramlington, United Kingdom
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Utomo B, Romadlona NA, Naviandi U, BaharuddinNur RJ, Makalew R, Liyanto E, Nanwani S, Dibley MJ, Hull TH. Census block based loglinear regression analysis of health and social determinants of maternal mortality in Indonesia 2010-2021. Sci Rep 2025; 15:9397. [PMID: 40102491 PMCID: PMC11920268 DOI: 10.1038/s41598-025-91942-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2024] [Accepted: 02/24/2025] [Indexed: 03/20/2025] Open
Abstract
Despite many health program efforts, the maternal mortality in Indonesia has slowly declined and remains high. A comprehensive understanding of social determinants of maternal mortality is needed to guide improved strategies to accelerate reductions in maternal mortality. This study aimed to assess the health-program and social factors that determine maternal mortality in Indonesia through census block-based log-linear regression analysis of recent large surveys. The following data sets were used: (1) the Indonesia Intercensal Population Survey 2015 merged to the Village Potential Census, 2014; and (2) the Indonesia Population Census 2020-Long Form (conducted in 2022) merged to the Village Potential Census, 2021. Both surveys used the same multistage sampling procedure to select 40,728 and 268,223 census blocks. In each selected census block, a "take all take some" procedure was used to randomly select 16 households. Maternal mortality, its health-program, and social factors were measured at the census block level. Since many census blocks had zero maternal death, a log-linear regression, modelled as Ln Y'i = α + βi Xi, was employed. Ln Y'i is the natural log transform of maternal mortality ratio; Xi are the factors investigated; βi is the regression coefficient of Xi on Ln Y'i. βi measures the extent influence of Xi on Yi. On the study results, the maternal mortality has declined but remains high, and geographic and socioeconomic disparities in maternal mortality have reduced, although they are still striking. There are many factors that have influenced the risk of maternal mortality. Proximity to hospital reduced the risk of maternal mortality. The primary health care system is not yet optimal for reducing the risk of maternal death. Traditional birth attendants hinder the referral for maternal complications. Lack of household transportation increases the risk of maternal mortality. The use of contraception to reduce high-risk births also reduces the risk of maternal mortality. Poverty and low maternal education independently increase the risk of maternal death. Households that are too large; have one or more disabled member; and have experienced child loss are at high risk of maternal mortality. Lack of village electrification and a polluted environment independently increase the risk of maternal mortality. The study results imply the need for multiple strategic interventions to accelerate the reduction of maternal mortality. Optimizing the coverage of quality referral hospitals, particularly in the eastern region, is required. There is a need to facilitate easy transportation from households to the nearest functional EmMONC. There is a need to strengthen the primary health care system to early detect, stabilize, and facilitate timely, safe, and effective referral of cases of maternal complications. Social health insurance should not only cover the cost of health care but also improve the quality of healthcare services. The role of traditional birth attendants should be shifted away from delivery care to improve maternal and neonatal health care. Family planning programs should focus on preventing high-risk births. Women's education needs to be improved. Electrification of all villages and control of environmental pollution to reduce maternal deaths.
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Affiliation(s)
- Budi Utomo
- Department of Population and Biostatistics, and Center for Health Research, Faculty of Public Health Universitas Indonesia, Depok, West Java, Indonesia.
| | - Nohan Arum Romadlona
- Department of Public Health, Faculty of Sport Science, Universitas Negeri Malang, Malang, East Java, Indonesia
| | | | - Ryza Jazid BaharuddinNur
- Department of Epidemiology, Faculty of Public Health, Universitas Hasanuddin, Makassar, Indonesia
| | | | | | | | - Michael J Dibley
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Terence H Hull
- School of Demography, Research School of Social Science, Australian National University, Canberra, Australia
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Hodgins S, Lehmann U, Perry H, Leydon N, Scott K, Agarwal S, Marcus H, Ved R, Olivas E, Ballard M, Mbewe D, Odera M, Petit Homme S, Otieno B, Wutete P, Chikumba A, Muyingo P, Kyakuha J, Harcourt E, Chowdhury M, Musoke D, Niyoyitungira T, Olaniran A, Williams JKA, e Méllo LMBDD, dos Santos RC, Pinto ICDM, Shrestha R, Sadruddin S, Morrow M, Sarriot E, Kok M, Pratap B. Comparing apples with apples: A proposed taxonomy for "Community Health Workers" and other front-line health workers for international comparisons. PLOS GLOBAL PUBLIC HEALTH 2025; 5:e0004156. [PMID: 39913354 PMCID: PMC11801544 DOI: 10.1371/journal.pgph.0004156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/09/2025]
Abstract
This paper proposes a taxonomy for Community Health Workers (CHWs) and others engaged in front-line community health activities, encompassing formally-employed workers extending government primary health care (PHC) service delivery as well as a range of other actors with roles at the nexus of government PHC and communities. The taxonomy is grounded in current definitions from the World Health Organization and the International Labor Organization, and proposes some refinements for future iterations of guidance from these agencies. The designation, "Community Health Worker" is currently used to cover a broad range of roles. Furthermore, there are programs engaging workers or community members in roles closely adjacent to those generally recognized as CHWs that use other designations, not commonly included under the rubric of "CHW". This potentially confusing range of roles and nomenclature leads at times to over-generalizations, applying insights and principles relevant for one type of worker or community member that are not necessarily relevant for another. It also leads to a failure to consider occupational groups not commonly thought of as CHWs-but engaged in PHC service delivery at the most peripheral level-in community-based-PHC planning and management arrangements. Building on ILO and WHO classifications and standards, a further clarification of terms and a taxonomy is proposed, with the intention of contributing to clearer communication and shared understanding and, ultimately, sounder community health policy, program planning, and implementation; and more substantial progress towards Universal Health Coverage.
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Affiliation(s)
- Stephen Hodgins
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Uta Lehmann
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Henry Perry
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Nicholas Leydon
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Kerry Scott
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Smisha Agarwal
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Hannah Marcus
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Rajani Ved
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Elijah Olivas
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Madeleine Ballard
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Dickson Mbewe
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Margaret Odera
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Sherlie Petit Homme
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Benard Otieno
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Pasipano Wutete
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Angeline Chikumba
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Prossy Muyingo
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - John Kyakuha
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Emmanuel Harcourt
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Morseda Chowdhury
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - David Musoke
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Thadee Niyoyitungira
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Abimbola Olaniran
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | | | | | | | | | - Ram Shrestha
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Salim Sadruddin
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Melanie Morrow
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Eric Sarriot
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Maryse Kok
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Bhanu Pratap
- School of Public Health, University of the Western Cape, Cape Town, South Africa
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Omidvar Tehrani S, Perkins DD, Mihaylov NL. A Political-Economic Model of Community and Societal Health Resources: A 92-Country Global Analysis. SOCIOLOGY OF HEALTH & ILLNESS 2025; 47:e13865. [PMID: 39584813 PMCID: PMC11849769 DOI: 10.1111/1467-9566.13865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 04/30/2024] [Accepted: 10/17/2024] [Indexed: 11/26/2024]
Abstract
The quality and access to healthcare systems depend on community health resources, infrastructure, and funding; however, a significant disparity in these resources persists globally. The effectiveness of national health systems depends on a balanced approach to health spending, access to facilities and a skilled local health workforce. What accounts for country-level differences in those critical community and societal health resources? We proposed and tested a model that leverages political and socioeconomic factors to predict various health resources and services in countries. Data, including community health training, research, and support, universal health coverage, healthcare infrastructure, and per capita health expenditure, were collected and analysed by statistical methods, like bivariate correlations and hierarchical multiple linear regressions from 105 countries. Countries with more grassroots activism, fiscal decentralisation, freedom, and globalisation and less perceived corruption and inequality had more community and societal health resources. In multivariate analyses, stronger community health training and research is associated with the globalisation index, freedom score, government fiscal decentralisation, and income inequality. The strongest predictor of health insurance coverage and hospital beds was the country's population education index, and of nurses and midwives-per-capita and health expenditures-per-capita was GDP-per-capita. These insights could guide policymaking to reduce global health inequalities.
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Affiliation(s)
- Shadi Omidvar Tehrani
- Department of Human and Organizational DevelopmentVanderbilt UniversityNashvilleTennesseeUSA
| | - Douglas D. Perkins
- Department of Human and Organizational DevelopmentVanderbilt UniversityNashvilleTennesseeUSA
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Guo Z, Ji W, Yan M, Shi Y, Chen T, Bai F, Wu Y, Guo Z, Song L. Global, Regional and National Burden of Maternal Obstructed Labour and Uterine Rupture, 1990-2021: Global Burden of Disease Study 2021. Paediatr Perinat Epidemiol 2025; 39:135-145. [PMID: 39659062 DOI: 10.1111/ppe.13156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 11/20/2024] [Accepted: 11/29/2024] [Indexed: 12/12/2024]
Abstract
BACKGROUND Maternal obstructed labour and uterine rupture (MOLUR) are among the major maternal labour complications that threaten maternal and child health. OBJECTIVE The objective of this study was to systematically analyse the global burden of MOLUR using the Global Burden of Disease 2021 (GBD 2021) database to inform further improvements in maternal-related public health policies. METHODS Incidence and disability-adjusted life-year (DALY) data on MOLUR from 1990 to 2021 were collected in the GBD 2021. The joinpoint and Bayesian age-period-cohort models were used to analyse and predict time burden trends. The slope index and concentration index were used to evaluate health inequality. Frontier analysis was used to visualise the potential for burden reduction in individual countries or territories. RESULTS In 2021, 13,471,093 (95% uncertainty interval [UI] 8,938,373, 19,008,282) incident cases of MOLUR were reported worldwide, which caused 1,067,270 (95% UI 896,161, 1,275,042) DALYs. Over the past three decades, there has been an overall downward trend in the age-standardised incidence rate (ASIR) and age-standardised DALY rate (ASDR) of MOLUR globally, with the ASIR decreasing from 554.0 (95% UI 355.6, 786.3) per 100,000 in 1990 to 347.0 (95% UI 228.8, 489.4) in 2021. The ASDR decreased from 65.4 (95% UI 56.0, 75.7) per 100,000 in 1990 to 27.0 (95% UI 22.7, 32.2) in 2021. By 2040, the global ASIRs and ASDRs projections for MOLUR will likely continue to decline. Socioeconomic-related inequalities are narrowing, but the burden remains concentrated in low socioeconomically developed countries. Israel and Afghanistan showed the largest differences from the frontier boundaries of ASIR and ASDR. CONCLUSIONS Although the global burden of MOLUR has declined in the last three decades, it remains high and is still concentrated in economically underdeveloped countries. The reduction in DALYs attributable to MOLUR globally reflects significant progress in improving maternal health and reducing complications of childbirth.
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Affiliation(s)
- Zhifeng Guo
- Nanyang Maternal and Child Health Care Hospital, Nanyang Central Hospital, Nanyang, China
| | - Wangquan Ji
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Mengqing Yan
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yang Shi
- Nanyang Maternal and Child Health Care Hospital, Nanyang Central Hospital, Nanyang, China
| | - Teng Chen
- Nanyang Maternal and Child Health Care Hospital, Nanyang Central Hospital, Nanyang, China
| | - Fanghui Bai
- Research Department, Nanyang Central Hospital, Nanyang, China
| | - Yu Wu
- Nanyang Maternal and Child Health Care Hospital, Nanyang Central Hospital, Nanyang, China
| | - Zhe Guo
- Nanyang Maternal and Child Health Care Hospital, Nanyang Central Hospital, Nanyang, China
| | - Linlin Song
- Nanyang Maternal and Child Health Care Hospital, Nanyang Central Hospital, Nanyang, China
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Chongwo EJ, Aoko B, Kaniala M, Esala M, Magoma P, Njoroge E, Nyamanya S, Marangu J, Khamis A, Ng’asike J, Huizink AC, Abubakar A. Intersection between individual, household, environmental and system level factors in defining risk and resilience for children in Kenya's ASAL: A qualitative study. PLoS One 2025; 20:e0316679. [PMID: 39823504 PMCID: PMC11741590 DOI: 10.1371/journal.pone.0316679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 12/14/2024] [Indexed: 01/19/2025] Open
Abstract
INTRODUCTION Children growing up in arid and semi-arid regions of Sub-Saharan Africa (SSA) face heightened risks, often resulting in poor developmental outcomes. In Kenya, the arid and semi-arid lands (ASAL) exhibit the lowest health and developmental indicators among children. Despite these risks, some children grow up successfully and overcome the challenges. However, there is limited comprehensive data on sources of risks and resilience in these children, particularly research that incorporates community perspectives and indigenous knowledge. Systematic documentation of factors influencing child outcomes is crucial for understanding the overall burden, informing policy and implementing targeted interventions. This study aimed at bridging this gap. METHODS The study was conducted in 10 ASAL counties in Kenya. Purposive and snowballing techniques were used to recruit 11 key informants per site with varied levels of involvement in early childhood development and primary caregivers. Using a semi-structured interview guide, 103 telephonic interviews were conducted between June and August 2022, involving 68 key informants and 35 caregivers. Thematic approach was used to analyze the data, using NVIVO software. RESULTS The mean age of the participants was 44years (SD = 11 years). The findings, viewed through the lens of Bronfenbrenner's ecological systems theory, reveal a complex interplay of contextual factors impacting children's development. These factors range from individual and biological aspects to family, community, systemic, and environmental level, including climatic challenges. Identified risk factors encompassed issues such as young caregiver's age, low literacy, mental health issues, drug abuse, domestic violence, malnutrition, poverty, lack of paternal involvement, early marriages, female genital mutilation, drought, heat stress, and insecurity. Nonetheless, sources of resilience include breastfeeding, immunization, responsive caregiving, family and community support, higher socio-economic status (SES), cultural practices, self-motivation, hard work, community role models, religious activities and quality service provision. CONCLUSION Urgent attention is needed to address the multifaceted challenges faced by children in ASAL regions. The study underscores the importance of addressing the root causes of risks while harnessing community strengths and resources to safeguard and promote the holistic development of these children.
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Affiliation(s)
- Esther Jebor Chongwo
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
- Faculty of Behavioural and Movement Sciences, Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Barack Aoko
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Martha Kaniala
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Moses Esala
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Phillis Magoma
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Eunice Njoroge
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Susan Nyamanya
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Joyce Marangu
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Anil Khamis
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
- University College London-Institute of Education, London, United Kingdom
| | | | - Anja C. Huizink
- Faculty of Behavioural and Movement Sciences, Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Amina Abubakar
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
- Kenya Medical Research Institute/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
- Department of Psychiatry, University of Oxford, London, United Kingdom
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Nakashima C, Tanaka K, Shinmasu Y, Ikeuchi S, Nagata K. Recovery in Mother-To-Mother Peer Supporters Who Have Experienced Difficulties in Child-Rearing: A Phenomenological Study. J Adv Nurs 2024. [PMID: 39729467 DOI: 10.1111/jan.16712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 11/27/2024] [Accepted: 12/17/2024] [Indexed: 12/29/2024]
Abstract
AIMS To elucidate the meaning of recovery for mothers who have experienced difficulties in child-rearing, using insights gained through their activities as mother-to-mother peer supporters. DESIGN Phenomenological study. METHODS From January to October 2022, semi-structured interviews were conducted with 11 mothers active as peer supporters at community child-rearing support centres in Japan. Data were analysed using Colaizzi's phenomenological methodology. RESULTS The analysis identified three clustered themes: (1) struggles as a mother, (2) discovery of one's authentic self, and (3) transformation in one's approach to life. The essential needs of mothers during child-rearing were clarified, revealing the vital importance of the mother's mental health compared with merely providing technical support or advice for child-rearing. CONCLUSION During child-rearing, in the context of their relationships with their children, mothers may feel profound loneliness and question their own self-worth. Life's difficulties are more keenly felt, and the inherent, seemingly insurmountable challenges that they face as mothers are more evident. Therefore, instead of merely focusing on traditional child-rearing methods, it is essential to support mothers in addressing their inherent personality traits, unresolved issues, and internal conflicts. IMPACT This study clarifies that child-rearing support is not merely about providing direct aid to children-in other words, a type of technical assistance-and attests to the importance of child-rearing support that focuses on mothers' own ways of living and being. Transcending national borders, these are vital insights for safeguarding the health of mothers and children and are expected to contribute to the global field of maternal and child health. REPORTING METHOD This study was conducted in accordance with the COREQ guidelines. PATIENT OR PUBLIC CONTRIBUTION None.
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Affiliation(s)
- Chieko Nakashima
- Doctoral Program, Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
- Department of Nursing, Faculty of Nursing, Osaka Aoyama University, Minoh, Japan
| | - Koji Tanaka
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Yuka Shinmasu
- Department of Nursing, Faculty of Nursing, Osaka Aoyama University, Minoh, Japan
| | - Satomi Ikeuchi
- Department of Public Health Nursing, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Kyoko Nagata
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
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Muralidharan O, Rehman S, Sihota D, Harrison L, Vaivada T, Bhutta ZA. Post-Asphyxial Aftercare and Management of Neonates in Low- and Middle-Income Countries: A Systematic Evidence Synthesis. Neonatology 2024; 122:84-105. [PMID: 39536730 PMCID: PMC11875422 DOI: 10.1159/000541862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 10/02/2024] [Indexed: 11/16/2024]
Abstract
INTRODUCTION Effective post-resuscitation care is crucial for improving outcomes in neonates post-asphyxia. This review aimed to provide a comprehensive overview of post-asphyxial aftercare strategies and forms part of a supplement describing an extensive synthesis of effective newborn interventions in low- and middle-income countries (LMICs). METHODS Evidence was generated by performing de novo reviews, updates to reviews via systematic searches, and reanalyses of studies conducted in LMICs from existing reviews. RESULTS Sixty-one trials recruiting 5,046 term infants post-asphyxia were included across all intervention domains. Limited studies were available from LMICs related to fluid restriction, antiseizure medications, and early interventions to improve developmental outcomes. Our reanalysis of whole-body cooling trials in LMICs found effects on neonatal mortality and mortality or neurological disability in infancy differed significantly based on the care center and type of cooling device used. Pharmacological therapies for neuroprotection evaluated in 27 trials in middle-income countries had varied effects in neonates with encephalopathy. Majority of the trials (60%) focused on magnesium sulfate therapy and showed significant improvements in short-term mortality and morbidities. CONCLUSION The sample sizes of included trials were relatively small, and the certainty of evidence ranged from very low to moderate. Evidence on long-term survival and neurodevelopmental outcomes was limited. Further research on promising neuroprotective therapies and factors affecting their implementation in low-resource contexts is required. To reduce the high burden related to asphyxia in LMICs, this review underscores the need for a paradigm shift toward prevention, and strategies that emphasize improving antenatal and obstetric care. INTRODUCTION Effective post-resuscitation care is crucial for improving outcomes in neonates post-asphyxia. This review aimed to provide a comprehensive overview of post-asphyxial aftercare strategies and forms part of a supplement describing an extensive synthesis of effective newborn interventions in low- and middle-income countries (LMICs). METHODS Evidence was generated by performing de novo reviews, updates to reviews via systematic searches, and reanalyses of studies conducted in LMICs from existing reviews. RESULTS Sixty-one trials recruiting 5,046 term infants post-asphyxia were included across all intervention domains. Limited studies were available from LMICs related to fluid restriction, antiseizure medications, and early interventions to improve developmental outcomes. Our reanalysis of whole-body cooling trials in LMICs found effects on neonatal mortality and mortality or neurological disability in infancy differed significantly based on the care center and type of cooling device used. Pharmacological therapies for neuroprotection evaluated in 27 trials in middle-income countries had varied effects in neonates with encephalopathy. Majority of the trials (60%) focused on magnesium sulfate therapy and showed significant improvements in short-term mortality and morbidities. CONCLUSION The sample sizes of included trials were relatively small, and the certainty of evidence ranged from very low to moderate. Evidence on long-term survival and neurodevelopmental outcomes was limited. Further research on promising neuroprotective therapies and factors affecting their implementation in low-resource contexts is required. To reduce the high burden related to asphyxia in LMICs, this review underscores the need for a paradigm shift toward prevention, and strategies that emphasize improving antenatal and obstetric care.
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Affiliation(s)
- Oviya Muralidharan
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Sarah Rehman
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Davneet Sihota
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Leila Harrison
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Tyler Vaivada
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Zulfiqar A. Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
- Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan
- Institute for Global Health and Development, The Aga Khan University, Karachi, Pakistan
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Zawolo G, Nyaaba GN, Nallo G, Kollie K, Thomson R, Raven J, Theobald S, Dean L. Transition and change: opportunities and challenges of CHW programme reform for community health systems and vertical disease programmes in Liberia. Health Res Policy Syst 2024; 22:141. [PMID: 39375677 PMCID: PMC11460177 DOI: 10.1186/s12961-024-01211-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 08/04/2024] [Indexed: 10/09/2024] Open
Abstract
BACKGROUND Globally, community health worker (CHW) programmes are critical to addressing health worker shortages and have been recognised as critical pillars within the drive towards universal health coverage (UHC). In 2016, the Liberian Ministry of Health launched the National Community Health Services Policy 2016-2021, which included significant CHW programme reform to address ongoing health workforce capacity gaps in the country. However, little consideration was given to the impact of such reforms on ongoing health interventions that rely heavily on the use of CHW cadres. Our study explores how CHW programme reform in Liberia influenced performance of CHWs involved in the delivery of Neglected Tropical Disease (NTD) programmes to elucidate how health systems reform can impact the delivery of routine health interventions and vice versa. METHODS We used a qualitative case study approach conducted between March 2017 and August 2018. Our instrumental case study approach uses qualitative methods, including document review of five CHW and NTD program-related policy documents; 25 key informant interviews with facility, county, and national level decision-makers; and 42 life and job histories with CHWs in Liberia. Data were analysed using a thematic framework approach, guided by Kok et al. framework of CHW performance. Data were coded in QRS NVIVO 11 Pro. RESULTS Our findings show that CHW programme reform provides opportunities and challenges for supporting enhanced CHW performance. In relation to health system hardware, we found that CHW programme reform provides better opportunities for: formal recognition of CHWs; strengthening capacity for effective healthcare delivery at the community level through improved and formalised training; a more formal supervision structure; and provision of monthly incentives of 70 US dollars. Efficiency gaps in routine intervention delivery can be mitigated through the strengthening of these hardware components. Conversely, supervision deficits in routine CHW functioning can be supported through health interventions. In relation to systems software, we emphasise the ongoing importance of community engagement in CHW selection that is responsive to gendered power hierarchies and accompanied by gendered transformative approaches to improving literacy. CONCLUSIONS This study shows how CHW programme reform provides opportunities and challenges for health system strengthening that can both positively and negatively impact the functioning of routine health interventions. By working together, CHW programmes and routine health interventions have the opportunity to leverage mutually beneficial support for CHWs, which can enhance overall systems functioning by enhancing CHW performance.
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Affiliation(s)
- Georgina Zawolo
- University of Liberia Pacific Institute for Research and Evaluation, University of Liberia, Capitol Hill, Monrovia, Liberia
| | - Gertrude Nsorma Nyaaba
- Department for International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, United Kingdom.
| | - Gartee Nallo
- University of Liberia Pacific Institute for Research and Evaluation, University of Liberia, Capitol Hill, Monrovia, Liberia
| | - Karsor Kollie
- Ministry of Health, Neglected Tropical Disease Programme, Monsterrado, Monrovia, Liberia
| | - Rachael Thomson
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, United Kingdom
| | - Joanna Raven
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, United Kingdom
| | - Sally Theobald
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, United Kingdom
| | - Laura Dean
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, United Kingdom.
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Behan J, Kabajaasi O, Derksen B, Sendegye G, Kugumikiriza B, Komugisha C, Sundararajan R, Jacob ST, Kenya-Mugisha N, Wiens MO. Caregivers' and nurses' perceptions of the Smart Discharges Program for children with sepsis in Uganda: A qualitative study. PLoS One 2024; 19:e0307089. [PMID: 39356657 PMCID: PMC11446420 DOI: 10.1371/journal.pone.0307089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 06/30/2024] [Indexed: 10/04/2024] Open
Abstract
Sepsis arises when the body's response to an infection injures its own tissues and organs. Among children hospitalized with suspected sepsis in low-income country settings, mortality rates following discharge are high, similar to mortality rates in hospital. The Smart Discharges Program uses a mobile health (mHealth) platform to identify children at high risk of post-discharge mortality to receive enhanced post-discharge care. This study sought to explore the perceptions and experiences of the caregivers and nurses of children enrolled into the Smart Discharges Program and the program's effect on post-discharge care. We conducted an exploratory qualitative study, which included in-person focus group discussions (FGDs) with 30 caregivers of pediatric patients enrolled in the Smart Discharges Program and individual, semi-structured interviews with eight Smart Discharges Program nurses. The study was carried out at four hospitals in Uganda in 2019. Following thematic analysis, three key themes pertaining to the Smart Discharges program were identified: (1) Facilitators and barriers to follow-up care after discharge; (2) Changed caregiver behavior following discharge; and (3) Increased involvement of male caregivers. Facilitators included telephone/text message reminders, positive nurse-patient relationship, and the complementary aspects of the program. Barriers included resource constraints and negative experiences during post-discharge care seeking. With regards to behavior, when provided with relevant and well-timed information, caregivers reported increased knowledge about post-discharge care and improvements in their ability to care for their child. Enrolment in the Smart Discharges Program also increased male caregiver involvement, increased provision of resources and improved communication within the family and with the healthcare system. The Smart Discharges approach is an impactful strategy to improve pediatric post-discharge care, and similar approaches should be considered to improve the hospital to home transition in similar low-income country settings.
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Affiliation(s)
- Justine Behan
- Institute for Global Health, BC Children's Hospital and BC Women's Hospital + Health Centre, Vancouver, Canada
| | | | - Brooklyn Derksen
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - George Sendegye
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | | | - Radhika Sundararajan
- Department of Emergency Medicine, Weill Cornell Center for Global Health, Weill Cornell Medicine, New York, NY, United States of America
| | - Shevin T Jacob
- Walimu, Kampala, Uganda
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | - Matthew O Wiens
- Institute for Global Health, BC Children's Hospital and BC Women's Hospital + Health Centre, Vancouver, Canada
- Walimu, Kampala, Uganda
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, Canada
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11
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Rao KD, Bairwa M, Mehta A, Hyat S, Ahmed R, Rajapaksa L, Adams AM. Improving urban health through primary health care in south Asia. Lancet Glob Health 2024; 12:e1720-e1729. [PMID: 39178875 DOI: 10.1016/s2214-109x(24)00121-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 02/19/2024] [Accepted: 03/06/2024] [Indexed: 08/26/2024]
Abstract
South Asia is rapidly urbanising. The strains of rapid urbanisation have profound implications for the health and equity of urban populations. This Series paper examines primary health care (PHC) in south Asian cities. Health and its social determinants vary considerably across south Asian cities and substantial socioeconomic inequities are present. Although cities offer easy geographical access to PHC services, financial hardship associated with health care use and low quality of care are a concern, particularly for low-income residents. Providing better PHC in south Asia requires a multi-sectoral response, with effective and resourced urban local bodies; increased public financing for health care; and new service delivery models aimed at low-income urban communities that involve strengthening public sector services, strengthening government engagement with private providers where necessary, and engaging with low-income communities and the PHC providers that serve them.
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Affiliation(s)
- Krishna D Rao
- Department of International Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Mohan Bairwa
- All India Institute of Medical Sciences, New Delhi, India
| | - Akriti Mehta
- Department of International Health, Johns Hopkins University, Baltimore, MD, USA
| | - Sana Hyat
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Rushdia Ahmed
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Lalini Rajapaksa
- Department of Community Medicine, University of Colombo, Colombo, Sri Lanka
| | - Alayne M Adams
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canda
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12
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Dias HS, Pereira AMM, Nunes EDFPDA, Martins CP, Castilho M, Mendonça FDF, de Lima LD. Political factors and arrangements influencing primary health care financing and resource allocation: A scoping review protocol. PLoS One 2024; 19:e0308754. [PMID: 39121167 PMCID: PMC11315285 DOI: 10.1371/journal.pone.0308754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 07/30/2024] [Indexed: 08/11/2024] Open
Abstract
INTRODUCTION Primary health care is a key element in the structuring and coordination of health systems, contributing to overall coverage and performance. PHC financing is therefore central in this context, with variations in sufficiency and regularity depending on the "political dimension" of health systems. Research that systematically examines the political factors and arrangements influencing PHC financing is justified from a global and multidisciplinary perspective. The scoping review proposed here aims to systematically map the evidence on this topic in the current literature, identifying groups, institutions, priorities and gaps in the research. METHODS AND ANALYSIS A scoping review will be conducted following the method proposed by Arksey and O'Malley to answer the following question: What is known from the literature about political factors and arrangements and their influence on and repercussions for primary health care financing and resource allocation models? The review will include peer-reviewed papers in Portuguese, English or Spanish published between 1978 and 2023. Searches will be performed of the following databases: Medline (PubMed), Embase, BVS Salud, Web of Science, Scopus and Science Direct. The review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. Inclusion and exclusion criteria will be used for literature screening and mapping. Screening and data charting will be conducted by a team of four reviewers. REGISTRATION This protocol is registered on the Open Science Framework (OSF) platform, available at https://doi.org/10.17605/OSF.IO/Q9W3P.
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Affiliation(s)
- Henrique Sant’Anna Dias
- Research and Innovation Vice-Direction, Sergio Arouca National School of Public Health, Rio de Janeiro, RJ, Brazil
| | - Adelyne Maria Mendes Pereira
- Department of Health Planning and Administration, Sergio Arouca National School of Public Health, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Marcela Castilho
- Department of Collective Health, Londrina State University, Londrina, Paraná, Brazil
| | | | - Luciana Dias de Lima
- Department of Health Planning and Administration, Sergio Arouca National School of Public Health, Rio de Janeiro, Rio de Janeiro, Brazil
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Amini E, Heidarzadeh M, Sohbati S, Behseresht M, Amiresmaili M. Exploring causes of neonatal mortality in south east of Iran: A qualitative study. Int J Health Plann Manage 2024; 39:22-35. [PMID: 37717258 DOI: 10.1002/hpm.3708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 07/25/2023] [Accepted: 09/01/2023] [Indexed: 09/19/2023] Open
Abstract
AIM Neonatal mortality (NM) is a significant global challenge that has a profound impact on families, particularly mothers. To address this challenge, the first step is to identify its underlying causes. Accordingly, this study aimed to explore the phenomenon by consulting with stakeholders, including mothers and experts. STUDY DESIGN This study utilized a qualitative design, conducting in-depth interviews with 16 mothers and 15 healthcare experts to gather information. A conventional content analysis approach was employed to analyze the data. RESULTS NM is influenced by personal, systemic, and socioeconomic factors. Personal factors can be further divided into those related to the neonate and those related to the mother. Systemic factors are primarily related to the healthcare system, while socioeconomic factors include low literacy, low income, lack of access to healthcare, and consanguineous marriage. CONCLUSION NM is influenced by a wide range of factors that require separate and targeted interventions to reduce its incidence. In the short term, priority should be given to preventable factors that can be addressed through simple interventions, such as screening mothers for urinary tract infections, educating mothers, and preparing them for pregnancy with necessary lab tests and supplements. In the long term, preventing premature birth, addressing maternal addiction, family poverty, and shortages in healthcare equipment and personnel must be thoroughly addressed.
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Affiliation(s)
- Elham Amini
- Health in Disaster and Emergencies Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Samira Sohbati
- Department of Obstetrics and Gynecology, Clinical Research Development Unit, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Maryam Behseresht
- Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammadreza Amiresmaili
- Health in Disaster and Emergencies Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Kaysin A, Antoniello P, Agarwal S, Perry H. Strategies for Sustained Empowerment of Community Health Workers: A Qualitative Analysis of the Comprehensive Rural Health Project in Jamkhed, India. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2024; 61:469580241235059. [PMID: 38424697 PMCID: PMC10908227 DOI: 10.1177/00469580241235059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/29/2024] [Accepted: 02/08/2024] [Indexed: 03/02/2024]
Abstract
To understand the core aspects of an empowerment-based Community Health Worker (CHW) training program, we studied the model of the Comprehensive Rural Health Project (CRHP) in Jamkhed, India-an organization known for facilitating empowerment of women as Village Health Workers (VHWs) and agents of community change. We define empowerment as a means by which individuals gain health and development-related skills and knowledge to facilitate positive change within their lives and communities. Using VHW training observations and semi-structured interviews with health workers and senior trainers, 6 themes were developed and applied in 4 focus group sessions with 18 multigenerational VHWs trained by the CRHP. Transcripts were qualitatively analyzed under 6 themes-selection, baseline training, continuing education and support, community participation, community empowerment, and commitment and longevity. Empowerment of VHWs was found to be an intentional process involving the creation of safe and supportive environments conducive to long-term participatory and experiential learning with professionals who facilitate and mentor. The impact of the baseline training is maintained through ongoing program-VHW interactions and knowledge reinforcement in both the field and training center. Importantly, these interactions reinforce VHWs' credibility and confidence in communities served. Community participation was found to be of key importance starting at the selection phase. The methods used for selection, training and ongoing support are critical to developing a cadre of competent, effective and motivated VHWs as well as fostering long-lasting self-development and leadership skills. Downstream effectiveness of community empowerment on health outcomes is demonstrated through indicators such as access to safe deliveries, declining child malnutrition rates, high vaccination rates as well as reductions in stigmatization of illness and caste discrimination.
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Affiliation(s)
- Alexander Kaysin
- Department of Family Medicine, University of Maryland Capital Region Health, Largo, MD, USA
| | - Patricia Antoniello
- Department of Anthropology and Archeology, Brooklyn College of the City University of New York, Brooklyn, NY, USA
| | - Smisha Agarwal
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Henry Perry
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Cho Y, Awoonor-Williams K, Jun D, Oh C, Cha S. Trial-based economic evaluation of the system-integrated activation of community health volunteers in rural Ghana. Glob Health Action 2023; 16:2203541. [PMID: 37165851 PMCID: PMC10177701 DOI: 10.1080/16549716.2023.2203541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 04/12/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Globally, steps to revitalise programmes deploying community health workers (CHWs) on a national scale have been growing, but few economic evaluations have been done on system-integrated CHW programmes. Ghana has dual cadres of CHWs: community health officers (CHOs) and community health volunteers (CHVs). CHO plays a major role in primary health services but has suffered from chronic staff shortages. We activated CHVs in communities to mitigate the negative impact due to CHO shortages. The CHVs conducted home visits and provided health education to prevent childhood diseases. OBJECTIVE We evaluated the cost-effectiveness and cost-benefit of activating CHVs. METHODS In a cluster-randomised trial with 40 communities in rural Ghana, the changes in disease incidence were inferred from a statistical model using a Bayesian generalised linear multilevel model. We evaluated the total incremental cost, benefit, and effectiveness for the intervention from an economic model. In cost-effectiveness analysis, disability-adjusted life years (DALYs) were estimated using a decision tree model. In the cost-benefit analysis, the cost-benefit ratio and net present value of benefit were estimated using a decision tree model, and a standardised sensitivity analysis was conducted. The decision tree model was a one-year cycle and run over 10-years. Costs, benefits, and effectiveness were discounted at a rate of 3% per year. RESULTS According to the cost-effectiveness analysis, the programme was highly likely to exceed the WHO-CHOICE threshold (1-3 times GDP per capita), but it was unlikely to exceed the conservative threshold (10-50% of GDP per capita). In the cost-benefit analysis, the mean and median cost-benefit ratios were 6.4 and 4.8, respectively. CONCLUSION We found the potential economic strengths in the cost-benefit analysis. To integrate CHW programmes with national health systems, we need more research to find the most effective scope of work for CHWs.
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Affiliation(s)
- Yinseo Cho
- West Africa Division, Korea International Cooperation Agency, Seongnam-si, Korea
| | - Koku Awoonor-Williams
- Policy, Planning, Monitoring and Evaluation Division, Ghana Health Service, Accra, Ghana
| | - Damin Jun
- Performance Management Team, Korea International Cooperation Agency, Seongnam-si, Korea
| | - Chunghyeon Oh
- Fiji Office, Korea International Cooperation Agency, Suva, Fiji
- Department of Surgery, CWM Hospital, Suva, Fiji
| | - Seungman Cha
- Department of Global Development and Entrepreneurship, Graduate School of Global Development and Entrepreneurship, Handong Global University, Pohang, South Korea
- Faculty of Infectious and Tropical Disease, London School of Hygiene & Tropical Medicine, London, UK
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Shrivastava R, Singh A, Khan A, Choubey S, Haney JR, Karyotaki E, Tugnawat D, Bhan A, Naslund JA. Stress Alleviation Methods for community-Based Health ActiVists (SAMBHAV): Development of a digital program for stress reduction for community health workers in rural India. SSM - MENTAL HEALTH 2023; 4:100230. [PMID: 38188869 PMCID: PMC10769151 DOI: 10.1016/j.ssmmh.2023.100230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024] Open
Abstract
Background Community health workers (CHWs) face high levels of stress (both professional and personal) and risk of burnout, highlighting the need for efforts to promote their mental health and well-being. This study seeks to develop a digital stress reduction program for CHWs in rural India. Methods A stepwise design process was employed to adapt and digitize the evidence-based World Health Organization's Self-Help Plus (SH+) intervention for addressing psychological distress among CHWs in Madhya Pradesh, India. This involved participatory design workshops with CHWs to ensure that the digital stress reduction intervention would be relevant for their needs and the local culture and context. Small groups of CHWs reviewed the adapted program content, allowing the research team to make refinements such as simplifying language, tailoring content to the local setting, and ensuring that program materials are both interesting and relevant. Simultaneously, the research team digitized the content, leveraging a combination of video and graphical content, and uploaded it to the Sangath Learning Management System, a digital platform accessible on a smartphone app. Results In total, 18 CHWs contributed to the adaptation of the SH+ content and digital intervention development. Participants commented on finding some terms difficult to follow and recommended simplifying the language and providing detailed explanations. Participants offered positive feedback on the adapted content, expressing that they found the examples covered in the material both relatable and relevant to their own personal experiences at home and in the workplace. By combining participants' insights and comments with feedback from content experts, it was possible to finalize a digital Hindi version of the SH+ intervention for CHWs in rural India. Conclusions This study is timely given the continued detrimental impacts of the COVID-19 pandemic, and offers a promising and potentially scalable digital program to alleviate psychological distress among frontline health workers.
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Affiliation(s)
| | | | | | | | | | - Eirini Karyotaki
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | | | - John A. Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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Ka'e AC, Nanfack A, Santoro MM, Yagai B, Ambada G, Sagnia B, Nka AD, Ngoufack Jagni Semengue E, Pabo W, Takou D, Sonela N, Colizzi V, Perno CF, Ceccherini-Silberstein F, Lewin SR, Tiemessen CT, Fokam J. Characterisation of HIV-1 reservoirs in paediatric populations: protocol for a systematic review and meta-analysis. BMJ Open 2023; 13:e073672. [PMID: 37816567 PMCID: PMC10565271 DOI: 10.1136/bmjopen-2023-073672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 09/15/2023] [Indexed: 10/12/2023] Open
Abstract
INTRODUCTION The success of antiretroviral therapy (ART) has changed HIV from a deadly to a chronic infection, thus increasing the transitioning from infancy toward adulthood. However, the virostatic nature of antiretrovirals maintains viruses in sanctuaries, with reactivation potentials. Because current ARTs are very limited for children, the emergence of new HIV epidemics driven by HIV drug-resistance mutations is favoured. Our systematic review aims to estimate the global burden of archived drug-resistance mutations (ADRMs) and the size of reservoir (HIV-1 DNA load), and their associated factors in children and adolescents. METHODS AND ANALYSIS Papers from the PubMed/MEDLINE, Google Scholar, ScienceDirect, African Journals Online and Academic Medical Education Databases will be systematically identified using the keywords: "HIV-1 reservoirs", "viral reservoirs", "HIV-1 DNA", infants, adolescents, child and children, linked by the following Boolean operators: 'OR' and 'AND'. Randomised and non-randomised trials, cohort studies and cross-sectional studies published in French or English from January 2002 will be included, while case reports, letters, comments, reviews, systematic reviews and meta-analyses, and editorials will be excluded. All studies describing data on ADRMs, HIV-1 DNA load and/or immunological markers among children/adolescents will be eligible. A random-effects model will be used to calculate the pooled prevalence of ADRMs. Data will be reported according to type of viral reservoir (peripheral blood mononuclear cells, CD4 cells), geographical location (country/continent), ethnicity/race, age (infants vs adolescents), gender, HIV-1 clades, ART exposure (naïve vs treated, drug class, type of regimen, age at ART initiation and treatment duration), WHO clinical staging (I, II, III, IV), immune status (immune compromised vs immune competent) and virological response (viraemic vs non-viraemic). Multivariate logistic regression will be performed to determine predictors of HIV reservoir profile in paediatric populations. The primary outcome will be to assess the genotypical and quantitative profile of HIV reservoirs, while the secondary outcomes will be to identify factors associated with ADRMs and reservoir size in paediatric populations. ETHICS AND DISSEMINATION Ethical approval is not applicable for this study as it will be based on published data. Results will be disseminated via a peer-reviewed scientific journal and relevant conferences. PROSPERO REGISTRATION NUMBER CRD42022327625.
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Affiliation(s)
- Aude Christelle Ka'e
- Laboratory of Virology, Chantal Biya International Reference Centre for HIV/AIDS Research on Prevention and Treatment, Yaounde, Cameroon, Yaounde, Cameroon
- Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Aubin Nanfack
- Laboratory of Immunology, Chantal Biya International Reference Centre for HIV/AIDS Research on Prevention and Treatment, Yaounde, Cameroon, Yaounde, Cameroon
| | | | - Bouba Yagai
- Central Technical Group, National AIDS Control Committee (NACC), Yaounde, Cameroon
| | - Georgia Ambada
- Laboratory of Immunology, Chantal Biya International Reference Centre for HIV/AIDS Research on Prevention and Treatment, Yaounde, Cameroon, Yaounde, Cameroon
| | - Bertrand Sagnia
- Laboratory of Immunology, Chantal Biya International Reference Centre for HIV/AIDS Research on Prevention and Treatment, Yaounde, Cameroon, Yaounde, Cameroon
| | - Alex Durand Nka
- Laboratory of Virology, Chantal Biya International Reference Centre for HIV/AIDS Research on Prevention and Treatment, Yaounde, Cameroon, Yaounde, Cameroon
| | - Ezechiel Ngoufack Jagni Semengue
- Laboratory of Virology, Chantal Biya International Reference Centre for HIV/AIDS Research on Prevention and Treatment, Yaounde, Cameroon, Yaounde, Cameroon
| | - Willy Pabo
- Faculty of Sciences, University of Buea, Buea, Cameroon
| | - Désiré Takou
- Laboratory of Virology, Chantal Biya International Reference Centre for HIV/AIDS Research on Prevention and Treatment, Yaounde, Cameroon, Yaounde, Cameroon
| | - Nelson Sonela
- Laboratory of Immunology, Chantal Biya International Reference Centre for HIV/AIDS Research on Prevention and Treatment, Yaounde, Cameroon, Yaounde, Cameroon
| | - Vittorio Colizzi
- Faculty of Sciences & Technology, Evangelic University of Cameroon, Bandjoun, Cameroon
| | | | | | - Sharon R Lewin
- The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Caroline T Tiemessen
- Cell Biology laboratory, National Institute for Communicable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - Joseph Fokam
- Laboratory of Virology, Chantal Biya International Reference Centre for HIV/AIDS Research on Prevention and Treatment, Yaounde, Cameroon, Yaounde, Cameroon
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
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Baynes C, Kanté AM, Exavery A, Tani K, Sikustahili G, Mushi H, Baraka J, Ramsey K, Sherr K, Weiner BJ, Phillips JF. The implementation and effectiveness of multi-tasked, paid community health workers on maternal and child health: A cluster-randomized pragmatic trial and qualitative process evaluation in Tanzania. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002050. [PMID: 37725612 PMCID: PMC10508634 DOI: 10.1371/journal.pgph.0002050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/22/2023] [Indexed: 09/21/2023]
Abstract
Community health worker programs have proliferated worldwide based on evidence that they help prevent mortality, particularly among children. However, there is limited evidence from randomized studies on the processes and effectiveness of implementing community health worker programs through public health systems. This paper describes the results of a cluster-randomized pragmatic implementation trial (registration number ISRCTN96819844) and qualitative process evaluation of a community health worker program in Tanzania that was implemented from 2011-2015. Program effects on maternal, newborn and child health service utilization, childhood morbidity and sick childcare seeking were evaluated using difference-in-difference regression analysis with outcomes measured through pre- and post-intervention household surveys in intervention and comparison trial arms. A qualitative process evaluation was conducted between 2012 and 2014 and comprised of in-depth interviews and focus group discussions with community health workers, community members, facility-based health workers and staff of district health management teams. The community health worker program reduced incidence of illness and improved access to timely and appropriate curative care for children under five; however, there was no effect on facility-based maternal and newborn health service utilization. The positive outcomes occurred because of high levels of acceptability of community health workers within communities, as well as the durability of community health workers' motivation and confidence. Implementation factors that generated these effects were the engagement of communities in program startup; the training, remuneration and supervision of the community health workers from the local health system and community. The lack of program effects on maternal and newborn health service utilization at facilities were attributed to lapses in the availability of needed care at facilities. Strategies that strengthen and align communities' and health systems core capacities, and their ability to learn, adapt and integrate evidence-based interventions, are needed to maximize the health impact of community health workers.
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Affiliation(s)
- Colin Baynes
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Almamy Malick Kanté
- Department of International Health, Johns Hopkins University, Baltimore, MD, United States of America
| | | | - Kassimu Tani
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | | | | | | | - Kate Ramsey
- Scope Impact, Brooklyn, NY, United States of America
| | - Kenneth Sherr
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Bryan J. Weiner
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - James F. Phillips
- Department of Population and Family Health, Columbia University, New York, NY, United States of America
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Schenkman S, Bousquat AEM, Facchini LA, Gil CRR, Giovanella L. Performance patterns of primary health care in the face of COVID-19 in Brazil: characteristics and contrasts. CAD SAUDE PUBLICA 2023; 39:e00009123. [PMID: 37729331 PMCID: PMC10511158 DOI: 10.1590/0102-311xpt009123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 05/26/2023] [Accepted: 06/06/2023] [Indexed: 09/22/2023] Open
Abstract
The adequate fight against pandemics requires effective coordination between primary health care (PHC) and health surveillance, guaranteed attention to acute and chronic demands, and a bond with the community dimension in the scope of basic health units (UBS, acronym in Portuguese). This study aims to contrast two extreme standards of PHC performance in the fight against COVID-19 in Brazil, comparing them with the profiles of the corresponding municipalities and characteristics of the organization of services. Based on the results of a cross-sectional national survey with a representative sample of UBSs, we created a synthetic index to evaluate how PHC performs against COVID-19 called CPI, composed of axes of health surveillance and social support (collective dimension) and of COVID-19 care and continuity of care (individual dimension). Of the 907 surveyed UBSs, 120 were selected, half of which had the highest indexes (complete standard) and the other half, the lowest ones (restricted standard). The municipalities of the UBSs with a complete standard are predominantly rural, have low Municipal Health Development Index (MHDI), high Family Health Strategy (FHS) coverage, and stand out in the collective dimension, whereas the UBSs in urban municipalities with this same standard have high MHDI, low FHS coverage, and an emphasis on the individual dimension. In the restricted standard, we highlight community health workers' reduced work in the territory. In the Brazilian Northeast, UBSs with complete standard predominate, whereas, in its Southeast, UBSs with restricted standard predominate. The study poses questions that refer to the role and organization of PHC in the health care network under situations that require prompt response to health issues and indicates the greater potential capacity of the FHS program in such situations.
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Affiliation(s)
- Simone Schenkman
- Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brasil
| | | | | | | | - Lígia Giovanella
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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20
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Nyagah LM, Bangura S, Omar OA, Karanja M, Mirza MA, Shajib H, Njiru H, Mengistu K, Malik SMMR. The importance of community health workers as frontline responders during the COVID-19 pandemic, Somalia, 2020-2021. Front Public Health 2023; 11:1215620. [PMID: 37663863 PMCID: PMC10469613 DOI: 10.3389/fpubh.2023.1215620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 08/01/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction We examined the contribution of community health workers as frontline responders for the community-based surveillance in Somalia during the first year of the COVID-19 pandemic for detection of COVID-19 cases and identification of contacts. Methods We retrieved COVID-19 surveillance data from 16 March 2020 to 31 March 2021 from the health ministry's central database. These data were collected through community health workers, health facilities or at the points of entry. We compared the number of suspected COVID-19 cases detected by the three surveillance systems and the proportion that tested positive using the chi-squared test. We used logistic regression analysis to assess association between COVID-19 infection and selected variables. Results During the study period, 154,004 suspected cases of COVID-19 were detected and tested, of which 10,182 (6.6%) were positive. Of the notified cases, 32.7% were identified through the community-based surveillance system, 54.0% through the facility-based surveillance system, and 13.2% at points of entry. The positivity rate of cases detected by the community health workers was higher than that among those detected at health facilities (8.6% versus 6.4%; p < 0.001). The community health workers also identified more contacts than those identified through the facility-based surveillance (13,279 versus 1,937; p < 0.001). The odds of COVID-19 detection generally increased by age. Community-based surveillance and health facility-based surveillance had similar odds of detecting COVID-19 cases compared with the points-of-entry surveillance (aOR: 7.0 (95% CI: 6.4, 7.8) and aOR: 7.5 (95% CI: 6.8, 8.3), respectively). Conclusion The community health workers proved their value as first responders to COVID-19. They can be effective in countries with weak health systems for targeted community surveillance in rural and remote areas which are not covered by the facility-based surveillance system.
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21
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Tang C, Fang P, Bai X, Min R, Liu C. Patient experience in community health services and first choice for medical attention: A cross-sectional study in Wuhan, China. PLoS One 2023; 18:e0288164. [PMID: 37490476 PMCID: PMC10368283 DOI: 10.1371/journal.pone.0288164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 06/21/2023] [Indexed: 07/27/2023] Open
Abstract
OBJECTIVES In China, it is up to the patients to choose between hospitals and primary care facilities to initiate their medical care. This study aimed to determine the association between patient experience with community health centres (CHCs, a predominant provider of community-based primary care) and patient preference of taking community-based primary care facilities as a first choice for medical attention. METHODS A questionnaire survey was conducted on 1919 patients who sought medical care in 55 CHCs in Wuhan, China. Respondents were asked to identify their preferred first choice for medical attention and rate their satisfaction with eight aspects of CHCs (basic facility, medical equipment, medical services, nursing services, treatment process, courtesy and responsiveness, time spent with medical doctor, pharmacy services). Multivariate logistic regression models were established to determine the association between the CHC experience and the first choice of providers after adjustment for variations in sociodemographic characteristics. RESULTS Over 90% of respondents were satisfied or very satisfied with the eight aspects of CHCs; but only 75% preferred to take community-based primary care facilities as their first choice for medical attention. Those who were older and had a lower income were more likely to choose community-based primary care facilities. Geographic proximity and higher levels of satisfaction with the basic facility, courtesy and responsiveness, and pharmacy services in the CHCs were associated with a higher likelihood of taking community-based primary care facilities as a first choice for medical attention. CONCLUSION The consumers of CHCs are generally satisfied with the services they received. However, one quarter of the CHC patients are yet to be convinced to accept community-based primary care facilities as a preferred first provider for medical care. Geographic proximity and patient experience with CHCs are associated with the patient choice.
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Affiliation(s)
- Changmin Tang
- School of Management, Hubei University of Chinese Medicine, Wuhan, Hubei, China
- Key Research Institute of Humanities and Social Sciences of Hubei Province, Wuhan, Hubei, China
| | - Pengqian Fang
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xue Bai
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Rui Min
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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22
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Erku D, Khatri R, Endalamaw A, Wolka E, Nigatu F, Zewdie A, Assefa Y. Community engagement initiatives in primary health care to achieve universal health coverage: A realist synthesis of scoping review. PLoS One 2023; 18:e0285222. [PMID: 37134102 PMCID: PMC10156058 DOI: 10.1371/journal.pone.0285222] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 04/17/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Community engagement (CE) is an essential component in a primary health care (PHC) and there have been growing calls for service providers to seek greater CE in the planning, design, delivery and evaluation of PHC services. This scoping review aimed to explore the underlying attributes, contexts and mechanisms in which community engagement initiatives contribute to improved PHC service delivery and the realisation of UHC. METHODS PubMed, PsycINFO, CINAHL, Cochrane Library, EMBASE and Google Scholar were searched from the inception of each database until May 2022 for studies that described the structure, process, and outcomes of CE interventions implemented in PHC settings. We included qualitative and quantitative studies, process evaluations and systematic or scoping reviews. Data were extracted using a predefined extraction sheet, and the quality of reporting of included studies was assessed using the Mixed Methods Appraisal Tool. The Donabedian's model for quality of healthcare was used to categorise attributes of CE into "structure", "process" and "outcome". RESULTS Themes related to the structural aspects of CE initiatives included the methodological approaches (i.e., format and composition), levels of CE (i.e., extent, time, and timing of engagement) and the support processes and strategies (i.e., skills and capacity) that are put in place to enable both communities and service providers to undertake successful CE. Process aspects of CE initiatives discussed in the literature included: i) the role of the community in defining priorities and setting objectives for CE, ii) types and dynamics of the broad range of engagement approaches and activities, and iii) presence of an on-going communication and two-way information sharing. Key CE components and contextual factors that affected the impact of CE initiatives included the wider socio-economic context, power dynamics and representation of communities and their voices, and cultural and organisational issues. CONCLUSIONS Our review highlighted the potential role of CE initiatives in improving decision making process and improving overall health outcomes, and identified several organisational, cultural, political, and contextual factors that affect the success of CE initiatives in PHC settings. Awareness of and responding to the contextual factors will increase the chances of successful CE initiatives.
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Affiliation(s)
- Daniel Erku
- Centre for Applied Health Economics, School of Medicine, Griffith University, SouthPort, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, SouthPort, Queensland, Australia
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Resham Khatri
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Aklilu Endalamaw
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Eskinder Wolka
- International Institute for Primary Health Care in Ethiopia, Addis Ababa, Ethiopia
| | - Frehiwot Nigatu
- International Institute for Primary Health Care in Ethiopia, Addis Ababa, Ethiopia
| | - Anteneh Zewdie
- International Institute for Primary Health Care in Ethiopia, Addis Ababa, Ethiopia
| | - Yibeltal Assefa
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
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23
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Hirve R, Adams C, Kelly CB, McAullay D, Hurt L, Edmond KM, Strobel N. Effect of early childhood development interventions delivered by healthcare providers to improve cognitive outcomes in children at 0-36 months: a systematic review and meta-analysis. Arch Dis Child 2023; 108:247-257. [PMID: 36732037 DOI: 10.1136/archdischild-2022-324506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 01/07/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To determine the effect of early childhood development interventions delivered by healthcare providers (HCP-ECD) on child cognition and maternal mental health. DESIGN Systematic review, meta-analysis. SETTING Healthcare setting or home. PARTICIPANTS Infants under 1 month of age. INTERVENTIONS HCP-ECD interventions that supported responsive caregiving, early learning and motor stimulation. MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Health Technology Assessment Database, Database of Abstracts of Reviews of Effects and Cochrane Database of Systematic Reviews were searched until 15 November 2021. Studies reporting prespecified outcomes were pooled using standard meta-analytical methods. MAIN OUTCOME MEASURES Cognitive development in children at 0-36 months. RESULTS Forty-two randomised controlled trials with 15 557 infants were included in the narrative synthesis. Twenty-seven trials were included in the meta-analyses. Pooled data from 13 trials suggest that HCP-ECD interventions may improve cognitive outcomes in children between 0 and 36 months (Bayley Scales of Infant Development version IIII (BSID-III) mean difference (MD) 2.65; 95% CI 0.61 to 4.70; 2482 participants; low certainty of evidence). Pooled data from nine trials suggest improvements in motor development (BSID-III MD 4.01; 95% CI 1.54 to 6.48; 1437 participants; low certainty of evidence). There was no evidence of improvement in maternal mental health (standardised MD -0.13; 95% CI -0.28 to 0.03; 2806 participants; 11 trials; low certainty of evidence). CONCLUSIONS We report promising evidence, particularly for cognitive and motor outcomes, of the effect of HCP-ECD interventions. However, effect sizes were small, and the certainty of evidence ranged from very low to moderate. Additional high-quality research is required. PROSPERO REGISTRATION NUMBER CRD42019122021.
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Affiliation(s)
- Raeena Hirve
- Women and Children's Health, King's College London, London, UK
| | - Claire Adams
- Edith Cowan University, Joondalup, Western Australia, Australia
| | - Clare B Kelly
- Women and Children's Health, King's College London, London, UK
| | - Daniel McAullay
- Edith Cowan University, Joondalup, Western Australia, Australia
| | - Lisa Hurt
- Population Medicine, Cardiff University, Cardiff, UK
| | - Karen M Edmond
- Women and Children's Health, King's College London, London, UK
| | - Natalie Strobel
- Edith Cowan University, Joondalup, Western Australia, Australia
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24
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Ashton RA, Hamainza B, Lungu C, Rutagwera MRI, Porter T, Bennett A, Hainsworth M, Burnett S, Silumbe K, Slater H, Eisele TP, Miller JM. Effectiveness of community case management of malaria on severe malaria and inpatient malaria deaths in Zambia: a dose-response study using routine health information system data. Malar J 2023; 22:96. [PMID: 36927440 PMCID: PMC10022244 DOI: 10.1186/s12936-023-04525-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 03/07/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Community case management of malaria (CCM) has been expanded in many settings, but there are limited data describing the impact of these services in routine implementation settings or at large scale. Zambia has intensively expanded CCM since 2013, whereby trained volunteer community health workers (CHW) use rapid diagnostic tests and artemether-lumefantrine to diagnose and treat uncomplicated malaria. METHODS This retrospective, observational study explored associations between changing malaria service point (health facility or CHW) density per 1000 people and severe malaria admissions or malaria inpatient deaths by district and month in a dose-response approach, using existing routine and programmatic data. Negative binomial generalized linear mixed-effect models were used to assess the impact of increasing one additional malaria service point per 1000 population, and of achieving Zambia's interim target of 1 service point per 750 population. Access to insecticide-treated nets, indoor-residual spraying, and rainfall anomaly were included in models to reduce potential confounding. RESULTS The study captured 310,855 malaria admissions and 7158 inpatient malaria deaths over 83 districts (seven provinces) from January 2015 to May 2020. Total CHWs increased from 43 to 4503 during the study period, while health facilities increased from 1263 to 1765. After accounting for covariates, an increase of one malaria service point per 1000 was associated with a 19% reduction in severe malaria admissions among children under five (incidence rate ratio [IRR] 0.81, 95% confidence interval [CI] 0.75-0.87, p < 0.001) and 23% reduction in malaria deaths among under-fives (IRR 0.77, 95% CI 0.66-0.91). After categorizing the exposure of population per malaria service point, there was evidence for an effect on malaria admissions and inpatient malaria deaths among children under five only when reaching the target of one malaria service point per 750 population. CONCLUSIONS CCM is an effective strategy for preventing severe malaria and deaths in areas such as Zambia where malaria diagnosis and treatment access remains challenging. These results support the continued investment in CCM scale-up in similar settings, to improve access to malaria diagnosis and treatment.
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Affiliation(s)
- Ruth A Ashton
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2300, New Orleans, LA, USA.
| | - Busiku Hamainza
- National Malaria Elimination Centre, Zambia Ministry of Health, Lusaka, Zambia
| | - Chris Lungu
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Lusaka, Zambia
| | | | - Travis Porter
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2300, New Orleans, LA, USA
| | | | | | | | - Kafula Silumbe
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Lusaka, Zambia
| | | | - Thomas P Eisele
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2300, New Orleans, LA, USA
| | - John M Miller
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Lusaka, Zambia
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25
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Bergström A, Hoa DP, Nga NT, Hoa T, Tu TT, Lien PTL, Trang T, Wallin L, Persson LÅ, Eriksson L. A facilitated social innovation: stakeholder groups using Plan-Do-Study-Act cycles for perinatal health across levels of the health system in Cao Bang province, Vietnam. Implement Sci Commun 2023; 4:24. [PMID: 36899419 PMCID: PMC9999598 DOI: 10.1186/s43058-023-00403-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 02/21/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Universal coverage of evidence-based interventions for perinatal health, often part of evidence-based guidelines, could prevent most perinatal deaths, particularly if entire communities were engaged in the implementation. Social innovations may provide creative solutions to the implementation of evidence-based guidelines, but successful use of social innovations relies on the engagement of communities and health system actors. This proof-of-concept study aimed to assess whether an earlier successful social innovation for improved neonatal survival that employed regular facilitated Plan-Do-Study-Act meetings on the commune level was feasible and acceptable when implemented on multiple levels of the health system (52 health units) and resulted in actions with plausibly favourable effects on perinatal health and survival in Cao Bang province, northern Vietnam. METHODS The Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework guided the implementation and evaluation of the Perinatal Knowledge-Into-Practice (PeriKIP) project. Data collection included facilitators' diaries, health workers' knowledge on perinatal care, structured observations of antenatal care, focus group discussions with facilitators, their mentors and representatives of different actors of the initiated stakeholder groups and an individual interview with the Reproductive Health Centre director. Clinical experts assessed the relevance of the identified problems and actions taken based on facilitators' diaries. Descriptive statistics included proportions, means, and t-tests for the knowledge assessment and observations. Qualitative data were analysed by content analysis. RESULTS The social innovation resulted in the identification of about 500 relevant problems. Also, 75% of planned actions to overcome prioritised problems were undertaken, results presented and a plan for new actions to achieve the group's goals to enhance perinatal health. The facilitators had significant roles, ensuring that the stakeholder groups were established based on principles of mutual respect. Overall, the knowledge of perinatal health and performance of antenatal care improved over the intervention period. CONCLUSIONS The establishment of facilitated local stakeholder groups can remedy the need for tailored interventions and grassroots involvement in perinatal health and provide a scalable structure for focused efforts to reduce preventable deaths and promote health and well-being.
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Affiliation(s)
- Anna Bergström
- SWEDESD, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. .,Institute for Global Health, University College London, London, UK.
| | - Dinh Phuong Hoa
- Research Institute for Child Health, Vietnam National Children's Hospital, Hanoi, Vietnam.,Hanoi University of Public Health, Hanoi, Vietnam
| | - Nguyen Thu Nga
- Research Institute for Child Health, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Trieu Hoa
- Provincial Reproductive Health Bureau, Provincial Health Bureau, Cao Bang, Vietnam
| | - Tran Thanh Tu
- Research Institute for Child Health, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Pham Thi Lan Lien
- Research Institute for Child Health, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Tran Trang
- Research Institute for Child Health, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Lars Wallin
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
| | | | - Leif Eriksson
- SWEDESD, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Public Health and Caring Science, Uppsala University, Uppsala, Sweden
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Story WT, Pyle DF. A blueprint for engaging communities to reduce inequities in maternal and child health: evidence from rural Guatemala. Int J Equity Health 2023; 21:151. [PMID: 36855138 PMCID: PMC9976359 DOI: 10.1186/s12939-022-01753-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Affiliation(s)
- William T Story
- Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, Iowa, USA.
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27
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Sul S, Ferreira L, Maia AC, Coelho A, Costa A. Sexually Transmitted Infections and Health Literacy: A Community-Based Preventive Program. J Prim Care Community Health 2023; 14:21501319231159973. [PMID: 36932868 PMCID: PMC10026141 DOI: 10.1177/21501319231159973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Sexually transmitted infections (STIs) are a public health problem with a high risk of morbidity and community transmissibility. Evidence points to their continuous increase. This study describes the design, development, and implementation of a community-based STI prevention program for community healthcare users. METHODS Based on the Health Planning Process design method, a structured, community-based intervention program on STI counseling and detection was conducted in a primary health care unit in Lisbon. Two data collection instruments were applied in the diagnosis of the situation, namely the Health Literacy Survey Portugal (ILS-PT) and the STD Attitude Scale, to 47 patients who attended the health consultation on STI counseling and detection in a primary care unit in Lisbon. Two interventions were implemented, the health education session and the provision of an educational poster. In the evaluation of the project, the acceptance and satisfaction of the patients with the implemented interventions were considered as outcome indicators. A descriptive statistical analysis of the data was performed. RESULTS The participants shows considerably low levels of health literacy and high-risk behaviors for acquiring STIs. After an intervention, a high percentage of the participants point out the project as exciting and valuable and reveal having acquired knowledge that allowed them to improve their health. Furthermore, the patients were very satisfied with the implemented health education session and the educational poster. CONCLUSION This project revealed the urgent and important need to implement community intervention projects to prevent STIs and promote health literacy among the most vulnerable groups.
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Affiliation(s)
- Susana Sul
- CIDNUR - Centro de Investigação, Inovação e Desenvolvimento em Enfermagem de Lisboa, Escola Superior de Enfermagem de Lisboa, Lisboa, Portugal
| | - Liliana Ferreira
- Agrupamento de Centros de Saúde de Lisboa Central, Lisbon, Portugal
| | - Ana Catarina Maia
- CIDNUR - Centro de Investigação, Inovação e Desenvolvimento em Enfermagem de Lisboa, Escola Superior de Enfermagem de Lisboa, Lisboa, Portugal
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Anabela Coelho
- University of Évora, Evora, Portugal
- Instituto Politécnico de Lisboa, Lisbon, Portugal
- Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Andreia Costa
- CIDNUR - Centro de Investigação, Inovação e Desenvolvimento em Enfermagem de Lisboa, Escola Superior de Enfermagem de Lisboa, Lisboa, Portugal
- ISAMB - Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Laboratório Associado TERRA, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- CRC-W-Católica Research Centre for Psychological, Family and Social Wellbeing, Universidade Católica Portuguesa, Lisboa, Portugal
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Murphy P, Hinde S, Fulbright H, Padgett L, Richardson G. Methods of assessing value for money of UK-based early childhood public health interventions: a systematic literature review. Br Med Bull 2022; 145:88-109. [PMID: 36542119 PMCID: PMC10075243 DOI: 10.1093/bmb/ldac035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 10/25/2022] [Accepted: 11/11/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Economic evaluation has an important role to play in the demonstration of value for money of early childhood public health interventions; however, concerns have been raised regarding their consistent application and relevance to commissioners. This systematic review of the literature therefore aims to collate the breadth of the existing economic evaluation evidence of these interventions and to identify the approaches adopted in the assessment of value. SOURCE OF DATA Recently published literature in Medline, EMBASE, EconLit, Health Management Information Consortium, Cochrane CENTRAL, Cochrane Database of Systematic Reviews, Health Technology Assessment, NHS EED and Web of Science. AREAS OF AGREEMENT The importance of the early childhood period on future health and well-being as well as the potential to impact health inequalities making for a strong narrative case for expenditure in early childhood public health. AREAS OF CONTROVERSY The most appropriate approaches to evaluating value for money of such preventative interventions relevant for UK decision-makers given the evident challenges. GROWING POINTS The presented review considered inconsistencies across methodological approaches used to demonstrate value for money. The results showed a mixed picture in terms of demonstrating value for money. AREAS TIMELY FOR DEVELOPING RESEARCH Future resource allocations decisions regarding early childhood public health interventions may benefit from consistency in the evaluative frameworks and health outcomes captured, as well as consistency in approaches to incorporating non-health costs and outcomes, incorporating equity concerns and the use of appropriate time horizons.
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Affiliation(s)
- Peter Murphy
- Centre for Health Economics, University of York, York, YO10 5DD, UK
| | - Sebastian Hinde
- Centre for Health Economics, University of York, York, YO10 5DD, UK
| | - Helen Fulbright
- Centre for Reviews and Dissemination, University of York, York, YO10 5DD, UK
| | - Louise Padgett
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Gerry Richardson
- Centre for Health Economics, University of York, York, YO10 5DD, UK
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Debele GR, Siraj SZ, Tsegaye D, Temesgen E. Determinants of neonatal near-miss among neonates delivered in public hospitals of Ilu Abba Bor Zone, Southwest Ethiopia: An unmatched case-control study during the COVID-19 pandemic. Front Public Health 2022; 10:923408. [PMID: 36203670 PMCID: PMC9531017 DOI: 10.3389/fpubh.2022.923408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/23/2022] [Indexed: 01/22/2023] Open
Abstract
Background The neonatal period is the time with the highest risk of neonatal and infant mortality. The COVID-19 pandemic diverted resources from routine maternal health services, which raises the possibility of neonatal near misses (NNMs). To implement prompt treatments that could improve the standard of infant care and lower neonatal mortality, it has been theorized that pinpointing the determinants of NNM during this outbreak is crucial. In light of this, the current study identified the determinants of NNM in neonates delivered in public hospitals of Ilu Abba Bor Zone, South West Ethiopia. Methods An institution-based unmatched case-control study was conducted among randomly selected 303 (101 cases and 202 controls) neonates admitted to Mettu Karl Comprehensive Specialized Hospital (MKCSH) and Darimu Primary Hospital (DPH) from 1 November to 28 December 2020. Data were collected using interviewer-administered structured questionnaire and checklist. The collected data were coded and entered into Epi-Data version 4.6 and then exported to SPSS version 20 for analysis. Adjusted odds ratios (AOR) along with a 95% confidence interval was used to assess the strength of the association, and a p-value < 0.05 was considered to declare the statistical significance in the multivariable logistic regression analysis. Result A total of 303 (101 cases and 202 controls) neonates admitted to MKCSH and DPH were included in the study making a 97.4% response rate. In the multivariable logistic regression analysis, no formal maternal education [AOR = 3.534, 95% CI: (1.194-10.455)], Breech presentation during birth [AOR = 3.088, 95% CI: (1.029-9.268)], < 4 antenatal care (ANC) visits [AOR = 1.920, 95% CI: (1.065-3.461], cesarean section delivery [AOR = 4.347, 95% CI: (1.718-10.996)], antepartum hemorrhage (APH) [AOR = 3.37, 95% CI: (1.23-9.24)], and hypertensive disorders of pregnancy (HDP) [AOR = 4.05, 95% CI: (2.36-11.05)] were independent determinants of NNM. Conclusion The study's result revealed that factors such as education level, birth presentation, ANC visit, mode of delivery, APH, and HDP continued to be important determinants of the NNM in Ethiopia during this pandemic. Therefore, much work is needed to improve neonatal health by providing adequate ANC services and other identified potential determinant factors that predispose the newborn to life-threatening (near-miss) conditions especially during this pandemic.
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Affiliation(s)
- Gebiso Roba Debele
- Department of Public Health, College of Health Sciences, Mettu University, Mettu, Ethiopia
| | - Sabit Zenu Siraj
- Department of Public Health, College of Health Sciences, Mettu University, Mettu, Ethiopia
| | - Dereje Tsegaye
- Department of Public Health, College of Health Sciences, Mettu University, Mettu, Ethiopia
| | - Ermiyas Temesgen
- Department of Public Health, Mettu Health Science College, Mettu, Ethiopia
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Bloomfield LSP, Tracey C, Mbabazi E, Schultz RL, Henderson R, Bardosh K, Randolph S, Paige S. Research Participation Influences Willingness to Reduce Zoonotic Exposure in Uganda. ECOHEALTH 2022; 19:299-314. [PMID: 35674864 DOI: 10.1007/s10393-022-01589-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 04/15/2022] [Indexed: 06/15/2023]
Abstract
The majority of emerging and re-emerging infectious diseases in people are zoonotic. Despite substantial research in communities adjacent to protected areas with high levels of biodiversity, limited data exist on people's knowledge, attitudes, and practices to avoid exposure to infections from domestic and wild animals. We used a modified grounded-theory framework in QS NVivo to develop a Knowledge, Attitude, and Practices (KAP) survey administered at two time points, KAPT1 (April-July 2016) and KAPT2 (February-May 2018) to participants living at the edge of Kibale National Park, Uganda. We measured the difference in willingness to engage in protective behaviors around zoonotic exposure between an Intervention group (n = 61) and a Comparison group (n = 125). Prior to KAPT1, the Intervention group engaged in a human-centered design (HCD) activity identifying behaviors that reduce zoonotic exposure (March-May 2016). Using a difference-in-difference approach, we compared the Intervention and Comparison groups to assess sustained willingness and use of protective behaviors against domestic and wild animal exposures. At KAPT1, Comparison group participants had a significantly lower (p < 0.05) level of willingness to engage in behaviors that increase exposure to zoonoses from domestic animals; Intervention group participants had a significantly higher (p < 0.01) level of willingness to engage in behaviors that increase exposure to zoonoses from wild animals. At KAPT2, the treatment effect was significant (p < 0.01) for sustained willingness to engage in protective behaviors for domestic animal exposure in the Intervention group. There were no significant differences in practices to avoid domestic and wild animal zoonotic exposure between the Intervention and Comparison groups.
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Affiliation(s)
- Laura S P Bloomfield
- Stanford University School of Medicine, Stanford University, Stanford, CA, 94305, USA.
- Emmett Interdisciplinary Program in Environment and Resources, Stanford University, Stanford, CA, 94305, USA.
| | - Christopher Tracey
- Milken Institute School of Public Health, George Washington University, Washington, DC, 20052, USA
| | - Edith Mbabazi
- Makerere University Biological Field Station, Kibale National Park, Kibale, Uganda
| | - Rhiannon L Schultz
- Department of Anthropology, University of Georgia, Athens, GA, 30602, USA
| | - Rebecca Henderson
- Department of Anthropology, University of Florida, Gainesville, FL, 32607, USA
| | - Kevin Bardosh
- Center for One Health Research, School of Public Health, University of Washington, Seattle, WA, 98195, USA
| | - Shannon Randolph
- School of Humanities and Sciences, Stanford University, Stanford, CA, 94305, USA
| | - Sarah Paige
- Global Health Institute, University of Wisconsin-Madison, Madison, WI, 53706, USA
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Kumar G, R.S. R. Availability of public health facilities and utilization of maternal and child health services in districts of India. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2022.101070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Kuo BJ, Busmanis I, Tan BP, Tan PH, Teoh WC, Tan BS. The Lancet Commission on diagnostics: What it means for Singapore. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2022; 51:300-303. [PMID: 35658153 DOI: 10.47102/annals-acadmedsg.202242] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
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Murewanhema G, Musuka G, Gwanzura C, Makurumidze R, Chitungo I, Chimene M, Tungwarara N, Dzinamarira T, Madziyire MG. Maternal, Sexual and Reproductive Health in Marginalised Areas: Renewing Community Involvement Strategies beyond the Worst of the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3431. [PMID: 35329118 PMCID: PMC8953553 DOI: 10.3390/ijerph19063431] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 03/05/2022] [Accepted: 03/13/2022] [Indexed: 01/27/2023]
Abstract
The COVID-19 pandemic and resultant lockdowns have brought unprecedented challenges for Maternal, Sexual and Reproductive Health (MSRH) services. Components of MSRH services adversely affected include antenatal, postnatal, and newborn care; provision of family planning and post-abortion care services; sexual and gender-based violence care and prevention; and care and treatment for sexually transmitted infections including HIV. Resuscitating, remodeling or inventing interventions to restore or maintain these essential services at the community level, as a gateway to higher care, is critical to mitigating short and long-term effects of the COVID-19 pandemic on essential MSRH. We propose a possible framework for community involvement and propose integrating key information, education, and communication of MSRH messages within COVID-19 messages.
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Affiliation(s)
- Grant Murewanhema
- Unit of Obstetrics and Gynaecology, Department of Primary Health Care Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare P.O. Box MP167, Zimbabwe; (G.M.); (C.G.); (M.G.M.)
| | - Godfrey Musuka
- ICAP at Columbia University, Harare P.O. Box MP167, Zimbabwe;
| | - Chipo Gwanzura
- Unit of Obstetrics and Gynaecology, Department of Primary Health Care Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare P.O. Box MP167, Zimbabwe; (G.M.); (C.G.); (M.G.M.)
| | - Richard Makurumidze
- Unit of Community Medicine, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare P.O. Box MP167, Zimbabwe;
| | - Itai Chitungo
- Chemical Pathology Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare P.O. Box MP167, Zimbabwe;
| | - Munashe Chimene
- Department of Health Sciences, Africa University, Mutare P.O. Box 1320, Zimbabwe;
| | - Nigel Tungwarara
- Department of Health Studies, University of South Africa, Pretoria 0002, South Africa;
| | - Tafadzwa Dzinamarira
- ICAP at Columbia University, Harare P.O. Box MP167, Zimbabwe;
- School of Health Systems & Public Health, University of Pretoria, Pretoria 0002, South Africa
| | - Mugove Gerald Madziyire
- Unit of Obstetrics and Gynaecology, Department of Primary Health Care Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare P.O. Box MP167, Zimbabwe; (G.M.); (C.G.); (M.G.M.)
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Sarriot E, Story WT. On Learning About Efforts to Strengthen (and Reduce Harm to) Systems for Health. Health Policy Plan 2022; 37:535-538. [PMID: 35137084 DOI: 10.1093/heapol/czac013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 01/03/2022] [Accepted: 02/04/2022] [Indexed: 11/13/2022] Open
Abstract
We comment on two embedded case studies of systems effects of successive mid-size projects looking back over 7-10 years, published in Health Policy and Planning. The papers examine humanitarian projects in Sudan and Pakistan and development projects (integrated Community Case Management) in Ethiopia, Malawi, and Mozambique. In this commentary, we summarize the two papers and discuss the overarching substantive and methodological lessons learned. In both development and humanitarian/emergency practice, projects navigate a dynamic space between gap-filling, systems support, and systems strengthening. In this, their contribution to systems strengthening depends heavily on the eco-system of government, development partners, and donors. Systems strengthening presents great challenges in definition, implementation, and measurement. Nonetheless, project implementers can and should renew their commitment to strengthening systems for health. This comes with a fundamental requirement for learning and evaluation.
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Affiliation(s)
- Eric Sarriot
- Formerly Save the Children, Department of Global Health, 899 North Capitol Street NE #900, Washington, DC 20002, USA
- Gavi, The Vaccine Alliance, Health Systems and Immunisation Strengthening Team, Chemin du Pommier 40, 1218 Grand-Saconnex, Geneva 1218, Switzerland
| | - William T Story
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, 145 N Riverside Dr, Iowa City, IA 52242, USA
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Diamond-Smith N, Gopalakrishnan L, Walker D, Fernald L, Menon P, Patil S. Is respectful care provided by community health workers associated with infant feeding practices? A cross sectional analysis from India. BMC Health Serv Res 2022; 22:95. [PMID: 35062930 PMCID: PMC8783456 DOI: 10.1186/s12913-021-07352-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 11/18/2021] [Indexed: 12/05/2022] Open
Abstract
Objectives Breastfeeding and complementary feeding practices in India do not meet recommendations. Community health care workers (CHWs) are often the primary source of information for pregnant and postpartum women about Infant and Young Child Feeding (IYCF) practices. While existing research has evaluated the effectiveness of content and delivery of information through CHWs, little is known about the quality of the interpersonal communication (respectful care). We analyzed the effect of respectful interactions on recommended IYCF practices. Methods We use data from evaluation of an at-scale mHealth intervention in India that serves as a job aid to the CHWs (n = 3266 mothers of children < 12 m from 841 villages in 2 Indian states). The binary indicator variable for respectful care is constructed using a set of 7 questions related to trust, respect, friendliness during these interactions. The binary outcomes variables are exclusive breastfeeding, timely introduction of complimentary feeding, and minimum diet diversity for infants. We also explore if most of the pathway from respectful care to improved behaviors is through better recall of messages (mediation analysis). All models controlled for socio-economic-demographic characteristics and number of interactions with the CHW. Results About half of women reported positive, respectful interactions with CHWs. Interactions that are more respectful were associated with better recall of appropriate health messages. Interactions that are more respectful were associated with a greater likelihood of adopting all child-feeding behaviors except timely initiation of breastfeeding. After including recall in the model, the effect of respectful interactions alone reduced. Conclusions Respectful care from CHWs appears to be significantly associated with some behaviors around infant feeding, with the primary pathway being through better recall of messages. Focusing on improving social and soft skills of CHWs that can translate into better CHW-beneficiary interactions can pay rich dividends. Funding This study is funded by Grant No. OPP1158231 from Bill and Melinda Gates Foundation. Trial registration number: 10.1186/ISRCTN83902145
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Haque M, Umar B, Abdullah A, Chowdhury K, Ahmad R. Does provision of antenatal care, post-natal care and perinatal care reduce maternal, neonatal and child mortality? With special attention towards bangladesh situation in global perspective. ADVANCES IN HUMAN BIOLOGY 2022. [DOI: 10.4103/aihb.aihb_85_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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White E, Mendin S, Kolubah FR, Karlay R, Grant B, Jacobs GP, Subah M, Siedner MJ, Kraemer JD, Hirschhorn LR. Impact of the Liberian National Community Health Assistant Program on childhood illness care in Grand Bassa County, Liberia. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000668. [PMID: 36962465 PMCID: PMC10021826 DOI: 10.1371/journal.pgph.0000668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 06/01/2022] [Indexed: 11/18/2022]
Abstract
Liberia launched its National Community Health Assistant Program in 2016, which seeks to ensure that all people living 5 kilometers or farther from a health facility have access to trained, supplied, supervised, and paid community health workers (CHWs). This study aims to evaluate the impact of the national program following implementation in Grand Bassa County in 2018 using data from population-based surveys that included information on 1291 illness episodes. We measured before-to-after changes in care for childhood illness by qualified providers in a portion of the county that implemented in a first phase compared to those which had not yet implemented. We also assessed changes in whether children received oral rehydration therapy for diarrhea and malaria rapid diagnostic tests if they had a fever by a qualified provider (facility based or CHW). For these analyses, we used a difference-in-differences approach and adjusted for potential confounding using inverse probability of treatment weighting. We also assessed changes in the source from which care was received and examined changes by key dimensions of equity (distance from health facilities, maternal education, and household wealth). We found that care of childhood illness by a qualified provider increased by 60.3 percentage points (95%CI 44.7-76.0) more in intervention than comparison areas. Difference-in-differences for oral rehydration therapy and malaria rapid diagnostic tests were 37.6 (95%CI 19.5-55.8) and 38.5 (95%CI 19.9-57.0) percentage points, respectively. In intervention areas, care by a CHW increased from 0 to 81.6% and care from unqualified providers dropped. Increases in care by a qualified provider did not vary significantly by household wealth, remoteness, or maternal education. This evaluation found evidence that the Liberian National Community Health Assistant Program has increased access to effective care in rural Grand Bassa County. Improvements were approximately equal across three measured dimensions of marginalization.
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Affiliation(s)
- Emily White
- Last Mile Health, Boston, Massachusetts, United States of America
| | | | | | | | | | | | | | - Mark J Siedner
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - John D Kraemer
- Department of Health Systems Administration, Georgetown University, Washington, D.C., United States of America
| | - Lisa R Hirschhorn
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
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Gopalakrishnan L, Diamond-Smith N, Avula R, Menon P, Fernald L, Walker D, Patil S. Association between supportive supervision and performance of community health workers in India: a longitudinal multi-level analysis. HUMAN RESOURCES FOR HEALTH 2021; 19:145. [PMID: 34838060 PMCID: PMC8627081 DOI: 10.1186/s12960-021-00689-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 11/13/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Community health workers (CHWs) deliver services at-scale to reduce maternal and child undernutrition, but often face inadequate support from the health system to perform their job well. Supportive supervision is a promising intervention that strengthens the health system and can enable CHWs to offer quality services. OBJECTIVES We examined if greater intensity of supportive supervision as defined by monitoring visits to Anganwadi Centre, CHW-supervisor meetings, and training provided by supervisors to CHWs in the context of Integrated Child Services Development (ICDS), a national nutrition program in India, is associated with higher performance of CHWs. Per program guidelines, we develop the performance of CHWs measure by using an additive score of nutrition services delivered by CHWs. We also tested to see if supportive supervision is indirectly associated with CHW performance through CHW knowledge. METHODS We used longitudinal survey data of CHWs from an impact evaluation of an at-scale technology intervention in Madhya Pradesh and Bihar. Since the inception of ICDS, CHWs have received supportive supervision from their supervisors to provide services in the communities they serve. Mixed-effects logistic regression models were used to test if higher intensity supportive supervision was associated with improved CHW performance. The model included district fixed effects and random intercepts for the sectors to which supervisors belong. RESULTS Among 809 CHWs, the baseline proportion of better performers was 45%. Compared to CHWs who received lower intensity of supportive supervision, CHWs who received greater intensity of supportive supervision had 70% higher odds (AOR 1.70, 95% CI 1.16, 2.49) of better performance after controlling for their baseline performance, CHW characteristics such as age, education, experience, caste, timely payment of salaries, Anganwadi Centre facility index, motivation, and population served in their catchment area. A test of mediation indicated that supportive supervision is associated indirectly with CHW performance through improvement in CHW knowledge. CONCLUSION Higher intensity of supportive supervision is associated with improved CHW performance directly and through knowledge of CHWs. Leveraging institutional mechanisms such as supportive supervision could be important in improving service delivery to reach beneficiaries and potentially better infant and young child feeding practices and nutritional outcomes. TRIAL REGISTRATION Trial registration number: https://doi.org/10.1186/ISRCTN83902145.
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Affiliation(s)
| | | | - Rasmi Avula
- International Food Policy Research Institute, Washington, DC, USA
| | - Purnima Menon
- International Food Policy Research Institute, Washington, DC, USA
| | - Lia Fernald
- University of California Berkeley, Berkeley, USA
| | - Dilys Walker
- University of California San Francisco, San Francisco, USA
| | - Sumeet Patil
- NEERMAN, Center for Causal Research and Impact Evaluation, Mumbai, India
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Hankins JS, Klesges LM. Bridging the implementation gap in medication adherence. If you build it, will they come? Br J Haematol 2021; 196:17-18. [PMID: 34786706 DOI: 10.1111/bjh.17953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 10/27/2021] [Indexed: 12/01/2022]
Affiliation(s)
| | - Lisa M Klesges
- Washington University in St Louis School of Medicine, St Louis, MO, USA
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Newton-Lewis TA, Bahety G. Evaluating the effectiveness of Community Health Worker home visits on infant health: A quasi-experimental evaluation of Home Based Newborn Care Plus in India. J Glob Health 2021; 11:04060. [PMID: 34737860 PMCID: PMC8542379 DOI: 10.7189/jogh.11.04060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Home visits by community health workers are promoted to improve the coverage and uptake of evidence-based newborn services and behaviours. However, evidence on the effectiveness of these home visits delivered through government systems at scale is limited, as is evidence from the post-neonatal period. From 2013 to 2017, the Government of India piloted an intervention called Home Based Newborn Care Plus with the goal of reducing pneumonia- and diarrhoea-related morbidity and malnutrition. Village-based Accredited Social Health Activists were incentivised to make quarterly home visits to infants between three and 12 months of age. After the pilot, the intervention was adapted and scaled up nationally (with an additional visit at 15 months of age) as a new programme called Home Based Care for Young Child. Methods The study used a quasi-experimental, difference-in-differences method to assess the quantitative impact on key outcome indicators by comparing changes over time in treatment districts with matched control districts. This was supplemented by a quantitative health worker survey and qualitative data collected at worker and community level. Results The intervention led to a significant increase in the number of home visits, and their content became more aligned with Home Based Newborn Care Plus protocols. However, absolute levels of coverage remained low. The intervention had no detectable effect on the key outcomes of feeding practices, handwashing, iron and folic acid and oral rehydration solution supplementation, growth monitoring, and immunisation. Conclusions Given the scale up of Home-Based Care for Young Child, there is a need to identify appropriate and comprehensive support for Accredited Social Health Activists to attain high coverage and quality and deliver impact. This will require reconsidering current design elements (such as incentives) and solving the underlying demand side and system level challenges (such as workload and supply chains) constraining Accredited Social Health Activists.
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Affiliation(s)
| | - Girija Bahety
- Economics Department and The Fletcher School, Tufts University, USA
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Perry HB, Chowdhury M, Were M, LeBan K, Crigler L, Lewin S, Musoke D, Kok M, Scott K, Ballard M, Hodgins S. Community health workers at the dawn of a new era: 11. CHWs leading the way to "Health for All". Health Res Policy Syst 2021; 19:111. [PMID: 34641891 PMCID: PMC8506098 DOI: 10.1186/s12961-021-00755-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND This is the concluding paper of our 11-paper supplement, "Community health workers at the dawn of a new era". METHODS We relied on our collective experience, an extensive body of literature about community health workers (CHWs), and the other papers in this supplement to identify the most pressing challenges facing CHW programmes and approaches for strengthening CHW programmes. RESULTS CHWs are increasingly being recognized as a critical resource for achieving national and global health goals. These goals include achieving the health-related Sustainable Development Goals of Universal Health Coverage, ending preventable child and maternal deaths, and making a major contribution to the control of HIV, tuberculosis, malaria, and noncommunicable diseases. CHWs can also play a critical role in responding to current and future pandemics. For these reasons, we argue that CHWs are now at the dawn of a new era. While CHW programmes have long been an underfunded afterthought, they are now front and centre as the emerging foundation of health systems. Despite this increased attention, CHW programmes continue to face the same pressing challenges: inadequate financing, lack of supplies and commodities, low compensation of CHWs, and inadequate supervision. We outline approaches for strengthening CHW programmes, arguing that their enormous potential will only be realized when investment and health system support matches rhetoric. Rigorous monitoring, evaluation, and implementation research are also needed to enable CHW programmes to continuously improve their quality and effectiveness. CONCLUSION A marked increase in sustainable funding for CHW programmes is needed, and this will require increased domestic political support for prioritizing CHW programmes as economies grow and additional health-related funding becomes available. The paradigm shift called for here will be an important step in accelerating progress in achieving current global health goals and in reaching the goal of Health for All.
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Affiliation(s)
- Henry B Perry
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | | | | | | | | | - Simon Lewin
- Norwegian Institute of Public Health, Oslo, Norway and Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - David Musoke
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Maryse Kok
- Department of Global Health, KIT Royal Tropical Institute, Amsterdam, The Netherlands
| | - Kerry Scott
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Independent Consultant, Toronto, Canada
| | - Madeleine Ballard
- Community Health Impact Coalition, New York, NY, USA
- Department of Health System Design and Global Health, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Steve Hodgins
- School of Public Health, University of Alberta, Edmonton, AB, Canada
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Masis L, Gichaga A, Zerayacob T, Lu C, Perry HB. Community health workers at the dawn of a new era: 4. Programme financing. Health Res Policy Syst 2021; 19:107. [PMID: 34641893 PMCID: PMC8506106 DOI: 10.1186/s12961-021-00751-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This is the fourth of our 11-paper supplement on "Community Health Workers at the Dawn of New Era". Here, we first make the case for investing in health programmes, second for investing in human resources for health, third for investing in primary healthcare (PHC) workers, and finally for investing in community health workers (CHWs). METHODS Searches of peer-reviewed journals and the grey literature were conducted with a focus on community health programme financing. The literature search was supplemented with a search of the grey literature for information about national health sector plans, community health strategies/policies, and costing information from databases of various countries' ministries of health, and finally a request for information from in-country partners. RESULTS The global shortage of human resources for health is projected to rise to 18 million health workers by 2030, with more acute shortages in Africa and South Asia. CHWs have an important role to play in mitigating this shortage because of their effectiveness (when properly trained and supported) and the feasibility of their deployment. Data are limited on the costs of current CHW programmes and how they compare to government and donor expenditures for PHC and for health services more broadly. However, available data from 10 countries in Africa indicate that the median per capita cost of CHW programmes is US$ 4.77 per year and US$ 2574 per CHW, and the median monthly salary of CHWs in these same countries is US$ 35 per month. For a subset of these countries for which spending for PHC is available, governments and donors spend 7.7 times more on PHC than on CHW programming, and 15.4 times more on all health expenditures. Even though donor funding for CHW programmes is a tiny portion of health-related donor support, most countries rely on donor support for financing their CHW programmes. CONCLUSION The financing of national CHW programmes has been a critical element that has not received sufficient emphasis in the academic literature on CHW programmes. Increasing domestic government funding for CHW programmes is a priority. In order to ensure growth in funding for CHW programmes, it will be important to measure CHW programme expenditures and their relationship to expenditures for PHC and for all health-related expenditures.
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Affiliation(s)
- Lizah Masis
- Financing Alliance for Health, Nairobi, Kenya
| | | | | | - Chunling Lu
- Brigham & Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Henry B Perry
- Department of International Health, Health Systems Program, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America.
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Abstract
BACKGROUND There is now rapidly growing global awareness of the potential of large-scale community health worker (CHW) programmes not only for improving population health but, even more importantly, for accelerating the achievement of universal health coverage and eliminating readily preventable child and maternal deaths. However, these programmes face many challenges that must be overcome in order for them to reach their full potential. FINDINGS This editorial introduces a series of 11 articles that provide an overview highlighting a broad range of issues facing large-scale CHW programmes. The series addresses many of them: planning, coordination and partnerships; governance, financing, roles and tasks, training, supervision, incentives and remuneration; relationships with the health system and communities; and programme performance and its assessment. Above all, CHW programmes need stronger political and financial support, and this can occur only if the potential of these programmes is more broadly recognized. The authors of the papers in this series believe that these challenges can and will be overcome-but not overnight. For this reason, the series bears the title "Community Health Workers at the Dawn of a New Era". The scientific evidence regarding the ability of CHWs to improve population health is incontrovertible, and the favourable experience with these programmes at scale when they are properly designed, implemented, and supported is compelling. CHW programmes were once seen as a second-class solution to a temporary problem, meaning that once the burden of disease from maternal and child conditions and from communicable diseases in low-income countries had been appropriately reduced, there would be no further need for CHWs. That perspective no longer holds. CHW programmes are now seen as an essential component of a high-performing healthcare system even in developed countries. Their use is growing rapidly in the United States, for instance. And CHWs are also now recognized as having a critically important role in the control of noncommunicable diseases as well as in the response to pandemics of today and tomorrow in all low-, middle-, and high-income countries throughout the world. CONCLUSION The promise of CHW programmes is too great not to provide them with the support they need to achieve their full potential. This series helps to point the way for how this support can be provided.
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Affiliation(s)
- Joseph M. Zulu
- Health Promotion and Education Department, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Henry B. Perry
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
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Sacks E, Yangchen S, Marten R. COVID-19, climate change, and communities. Lancet Planet Health 2021; 5:e663-e664. [PMID: 34627466 PMCID: PMC8497025 DOI: 10.1016/s2542-5196(21)00257-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/03/2021] [Accepted: 09/08/2021] [Indexed: 05/26/2023]
Affiliation(s)
- Emma Sacks
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD 21205, USA.
| | - Sonam Yangchen
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
| | - Robert Marten
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
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Wickremasinghe D, Alkali Hamza Y, Umar N, Willey B, Okolo M, Gana A, Shuaibu A, Anyanti J, Marchant T, Spicer N. 'A seamless transition': how to sustain a community health worker scheme within the health system of Gombe state, northeast Nigeria. Health Policy Plan 2021; 36:1067-1076. [PMID: 34131728 PMCID: PMC8359746 DOI: 10.1093/heapol/czab063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 04/27/2021] [Accepted: 05/26/2021] [Indexed: 11/13/2022] Open
Abstract
Health interventions introduced as part of donor-funded projects need careful planning if they are to survive when donor funding ends. In northeast Nigeria, the Gombe State Primary Health Care Development Agency and implementing partners recognized this when introducing a Village Health Worker (VHW) Scheme in 2016. VHWs are a new cadre of community health worker, providing maternal, newborn and child health-related messages, basic healthcare and making referrals to health facilities. This paper presents a qualitative study focussing on the VHW Scheme's sustainability and, hence, contributes to the body of literature on sustaining donor-funded interventions as well as presenting lessons aimed at decision-makers seeking to introduce similar schemes in other Nigerian states and in other low- and middle-income settings. In 2017 and 2018, we conducted 37 semi-structured interviews and 23 focus group discussions with intervention stakeholders and community members. Based on respondents' accounts, six key actions emerged as essential in promoting the VHW Scheme's sustainability: government ownership and transition of responsibilities, adapting the scheme for sustainability, motivating VHWs, institutionalizing the scheme within the health system, managing financial uncertainties and fostering community ownership and acceptance. Our study suggests that for a community health worker intervention to be sustainable, reflection and adaption, government and community ownership and a phased transition of responsibilities are crucial.
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Affiliation(s)
| | - Yashua Alkali Hamza
- Childcare and Wellness Clinics, 26 Anthony Enahoro Street, Utako, Abuja, Nigeria
| | - Nasir Umar
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Barbara Willey
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Magdalene Okolo
- Formerly with Society for Family Health, Justice Ifeyinwa Nzeako House, #8 Port Harcourt Crescent, Area 11, Garki, Abuja, Nigeria
| | - Ahmed Gana
- Gombe State Government, Dukku Road, Gombe, Nigeria
| | - Abdulrahman Shuaibu
- Gombe State Primary Health Care Development Agency, Jeka Da Fari, near Government science secondary school, 760212 Gombe, Nigeria
| | - Jennifer Anyanti
- Society for Family Health, Justice Ifeyinwa Nzeako House, #8 Port Harcourt Crescent, Area 11, Garki, Abuja, Nigeria
| | - Tanya Marchant
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Neil Spicer
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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Story WT, Pritchard S, Hejna E, Olivas E, Sarriot E. The role of integrated community case management projects in strengthening health systems: case study analysis in Ethiopia, Malawi and Mozambique. Health Policy Plan 2021; 36:900-912. [PMID: 33930137 DOI: 10.1093/heapol/czaa177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2020] [Indexed: 11/14/2022] Open
Abstract
Integrated community case management (iCCM) has now been implemented at scale globally. Literature to-date has focused primarily on the effectiveness of iCCM and the systems conditions required to sustain iCCM. In this study, we sought to explore opportunities taken and lost for strengthening health systems through successive iCCM programmes. We employed a systematic, embedded, multiple case study design for three countries-Ethiopia, Malawi and Mozambique-where Save the Children implemented iCCM programmes between 2009 and 2017. We used textual analysis to code 62 project documents on nine categories of functions of health systems using NVivo 11.0. The document review was supplemented by four key informant interviews. This study makes important contributions to the theoretical understanding of the role of projects in health systems strengthening by not only documenting evidence of systems strengthening in multi-year iCCM projects, but also emphasizing important deficiencies in systems strengthening efforts. Projects operated on a spectrum, ranging from gap-filling interventions, to support, to actual strengthening. While there were natural limits to the influence of a project on the health system, all successive projects found constructive opportunities to try to strengthen systems. Alignment with the Ministry of Health was not always static and simple, and ministries themselves have shown pluralism in their perspectives and orientations. We conclude that systems strengthening remains 'everybody's business' and places demands for realism and transparency on government and the development architecture. While mid-size projects have limited decision space, there is value in better defining where systems strengthening contributions can actually be made. Furthermore, systems strengthening is not solely about macro-level changes, as operational and efficiency gains at meso and micro levels can have value to the system. Claims of 'systems strengthening' are, however, bounded within the quality of evaluation and learning investments.
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Affiliation(s)
- William T Story
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, 145 N. Riverside Drive, Iowa City, IA 52242, USA
| | - Susannah Pritchard
- Formerly Save the Children, Health Department, 1 St. John's Lane, London EC1M 4AR, UK
| | - Emily Hejna
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, 145 N. Riverside Drive, Iowa City, IA 52242, USA
| | - Elijah Olivas
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, 145 N. Riverside Drive, Iowa City, IA 52242, USA
| | - Eric Sarriot
- Formerly Save the Children, Department of Global Health, 899 North Capitol St NE #900, Washington, DC 20002, USA
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Mushamiri I, Belai W, Sacks E, Genberg B, Gupta S, Perry HB. Evidence on the effectiveness of community-based primary health care in improving HIV/AIDS outcomes for mothers and children in low- and middle-income countries: Findings from a systematic review. J Glob Health 2021; 11:11001. [PMID: 34327001 PMCID: PMC8284540 DOI: 10.7189/jogh.11.11001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The effectiveness of community-based primary health care (CBPHC) interventions in low- and middle-income countries (LMICs), especially for maternal, neonatal and child health, is well established. However, there has not been a systematic review of the literature on the effectiveness of CBPHC on HIV outcomes derived from rigorous assessments of primary studies. Using peer-reviewed studies of randomized interventions or those containing a specified control group and directly measuring clinical HIV outcomes, we provide evidence for the effectiveness of CBPHC on HIV outcomes for mothers and children in low- and middle-income countries (LMICs). METHODS Eligibility criteria included studies assessing the effectiveness of community-based HIV interventions with or without a facility-based component, or multiple integrated projects, with outcome measures defining an aspect of HIV health status such as the utilization of prevention or health care services, nutritional status, serious morbidity (including clinical measures of HIV progression) or mortality of children aged five or younger and pregnant women. Articles published through June 3, 2020 were identified by searching four databases. The type of community-based projects implemented, the implementors, and the implementation strategies of each program were identified and the impact on HIV-related outcomes assessed. RESULTS The search yielded 10 537 articles; 4881 underwent title and abstract screening after removing duplicates. Of these, 117 studies qualified for full-text screening; only 22 were included in the final analysis. Most studies showed that community-based interventions improved HIV prevention and treatment outcomes compared to facility-based approaches alone. Each study had at least one statistically significant HIV-related outcome; the non-significant outcomes found in six of the 22 studies were mostly not related to HIV programming. Most interventions were implemented by community health workers; other implementers were government workers, community members, or research staff. Strategies used included peer-to-peer education, psychosocial support, training of community champions, community-based follow-up care, home-based care, and integrated care. CONCLUSIONS CBPHC strategies are effective in improving population-based, HIV-related health outcomes for mothers and children, especially in combination with facility-based approaches. However, there is a need to assess the scalability of such interventions and integrate them into existing health systems to assess their impact on the HIV pandemic in more routine settings.
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Affiliation(s)
- Ivy Mushamiri
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Wintana Belai
- Department of International Health, Division of Health Systems, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Emma Sacks
- Department of International Health, Division of Health Systems, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Becky Genberg
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sundeep Gupta
- University of California at Los Angeles, Los Angeles, California, USA
| | - Henry B Perry
- Department of International Health, Division of Health Systems, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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Leptin and adiponectin concentrations in infants with low birth weight: relationship with maternal health and postnatal growth. J Dev Orig Health Dis 2021; 13:338-344. [PMID: 34176551 DOI: 10.1017/s2040174421000349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Health in pregnancy and infancy can affect the risk of chronic non-communicable diseases. We aimed to describe leptin and adiponectin concentrations in low birth weight (LBW) infants and identify possible associations with maternal nutritional status, adequacy for gestational age, nutritional recovery, and current dietary intake. A cross-sectional study with LBW infants (9-12 months) including maternal background and pre-pregnancy nutritional condition was performed. From the Infants: anthropometry at birth and current was expressed as z-score (weight: WAZ, length, head circumference), nutritional recovery, dietary intake, leptin, and adiponectin blood concentrations. The mean age of the 54 infants was 10.0 ± 1.5 months, 32 (59.3%) were female, 36 (66.7%) preterm, 23 (42.6%) small for gestational age (SGA), and 25 pregnancies (46.3%) were twin. Almost all (98%) of the infants intake energy and protein above the recommendation, and 47 (87.6%) consumed ultra-processed foods. At the time of the assessment, 8 (14.8%) were overweight and 4 (7.4%) had short stature. SGA infants showed faster weight recovery (WAZ 1.54; 95% CI 1.17, 1.91; p = 0.001), higher leptin's concentration (3.0 ng/ml (1.7, 3.0) versus 1.6 ng/ml (0.9, 2.6); p = 0.032)), and leptin/adiponectin ratio (0.13 ± 0.08 versus 0.07 ± 0.07; p = 0.018). The pre-gestational BMI was a modifier of the effect of WAZ on leptin levels (p = 0.027) in LBW infants. Higher pre-gestational BMI increased the effect of WAZ variation (birth and current) on leptin levels. Concluding, LBW infants showed early changes in leptin and adiponectin concentrations, influenced by maternal (pre-gestational BMI), intrauterine (gestational age adequacy - SGA), and postnatal weight gain. This combination of factors may increase the risk of NCD for this group of children.
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Ilboudo B, Savadogo LGB, Traoré I, Meda CZ, Kinda M, Sombié I, Dramaix-Wilmet M, Donnen P. Effect of Personalized Support at Home on the Prevalence of Anemia in Pregnancy in Burkina Faso: A Cluster Randomized Trial. Am J Trop Med Hyg 2021; 105:207-216. [PMID: 34097646 DOI: 10.4269/ajtmh.20-1043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 03/01/2021] [Indexed: 11/07/2022] Open
Abstract
Burkina Faso has high prevalence of anemia in pregnancy (hemoglobin < 11 g/dL), despite the implementation of the WHO recommended guidelines. This study aimed to test the effects of personalized support for pregnant women at home on the trend of anemia prevalence in pregnancy. A cluster randomized trial was conducted from January 2015 to August 2016 at Sindou health district in Burkina Faso. Data were collected from 617 women in their first or second trimester of pregnancy, including 440 and 177 women in the intervention and control groups, respectively. The intervention consisted of a monthly home-based visit to the pregnant woman, focusing on nutritional counseling and pregnancy management, alongside an improvement antenatal visit quality. Compared with the prevalence of anemia in pregnancy in the control group [64.0% (95% confidence interval [CI]: 52.1-74.4%)], that of the intervention group was significantly lower from the fifth home visit onward [36.8% (95% CI: 32.1-41.8%)] (P < 0.001). The adjusted difference-in-differences in anemia prevalence between the two groups was -19.8% (95% CI: -30.2% to -9.4%) for women who received more than four home visits (P < 0.001). The corresponding difference in hemoglobin levels was 0.644 g/dL (95% CI: 0.309-0.167; P < 0.001). Personalized support for pregnant women at home, combined with appropriate antenatal care, can significantly reduce anemia prevalence during pregnancy in rural Burkina Faso.
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Affiliation(s)
- Bernard Ilboudo
- 1Centre Muraz, Institut National de Santé Publique, Bobo-Dioulasso, Burkina Faso.,3Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
| | - Léon G B Savadogo
- 2Institut Supérieur des Sciences de la Santé, Université Nazi Boni, Bobo-Dioulasso, Burkina Faso
| | - Isidore Traoré
- 1Centre Muraz, Institut National de Santé Publique, Bobo-Dioulasso, Burkina Faso.,2Institut Supérieur des Sciences de la Santé, Université Nazi Boni, Bobo-Dioulasso, Burkina Faso
| | - Clément Z Meda
- 2Institut Supérieur des Sciences de la Santé, Université Nazi Boni, Bobo-Dioulasso, Burkina Faso
| | - Maurice Kinda
- 2Institut Supérieur des Sciences de la Santé, Université Nazi Boni, Bobo-Dioulasso, Burkina Faso
| | - Issiaka Sombié
- 2Institut Supérieur des Sciences de la Santé, Université Nazi Boni, Bobo-Dioulasso, Burkina Faso
| | | | - Philippe Donnen
- 3Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
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Defar A, Alemu K, Tigabu Z, Persson LÅ, Okwaraji YB. Caregivers' and Health Extension Workers' Perceptions and Experiences of Outreach Management of Childhood Illnesses in Ethiopia: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073816. [PMID: 33917415 PMCID: PMC8038672 DOI: 10.3390/ijerph18073816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/26/2021] [Accepted: 03/31/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Ethiopian Health Extension Workers provide facility-based and outreach services, including home visits to manage sick children, aiming to increase equity in service coverage. Little is known about the scope of the outreach services and caregivers' and health workers' perceptions of these services. We aimed at exploring mothers' and health extension workers' perceptions and experiences of the outreach services provided for the management of childhood illnesses. METHODS Four focus groups and eight key informant interviews were conducted. A total of 45 community members participated. Interviews were recorded, transcribed verbatim, and translated into English. We applied thematic content analysis, identified challenges in providing outreach services, and suggestions for improvement. We balanced the data collection by selecting half of the participants for interview and focus group discussions from remote areas and the other half from areas closer to the health posts. RESULTS Mothers reported that health extension workers visited their homes for preventive services but not for managing childhood illnesses. They showed lack of trust in the health workers' ability to treat children at home. The health extension workers reported that they provide sick children treatment during outreach services but also stated that in most cases, mothers visit the health posts when their child is sick. On the other hand, mothers considered distance from home to health post not to be a problem if the quality of services improved. Workload, long distances, and lack of incentives were perceived as demotivating factors for outreach services. The health workers called for support, incentives, and capacity development activities. CONCLUSIONS Mothers and health extension workers had partly divergent perceptions of whether outreach curative services for children were available. Mothers wanted improvements in the quality of services while health workers requested capacity development and more support for providing effective community-based child health services.
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Affiliation(s)
- Atkure Defar
- Ethiopian Public Health Institute, Addis Ababa P.O. Box 1242, Ethiopia; (L.Å.P.); (Y.B.O.)
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar P.O. Box 196, Ethiopia;
- Correspondence:
| | - Kassahun Alemu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar P.O. Box 196, Ethiopia;
| | - Zemene Tigabu
- Department of Paediatrics and Child Health, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar P.O. Box 196, Ethiopia;
| | - Lars Åke Persson
- Ethiopian Public Health Institute, Addis Ababa P.O. Box 1242, Ethiopia; (L.Å.P.); (Y.B.O.)
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Yemisrach B. Okwaraji
- Ethiopian Public Health Institute, Addis Ababa P.O. Box 1242, Ethiopia; (L.Å.P.); (Y.B.O.)
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
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